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PUBLICATION EXCLUSIVE: Children with blepharitis often require specialized care
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As a specialist in cornea and external disease, I will focus my comments on the topic of blepharitis in the pediatric age group. Our children in America are currently growing up in what many experts call an “obesogenic environment.” In the U.S., one in three children under the age of 11 years is overweight and one in six has a BMI high enough to be considered obese. This obesogenic environment includes a saturated fatty acid and refined sugar rich diet with too many calories per day, reduced outdoor activity and exercise, and a lifestyle that includes hours of near work, computer games and television. Besides obesity, this lifestyle change is contributing to an epidemic of myopia, diabetes, hypertension and, yes, even meibomian gland dysfunction, blepharitis, and the associated hordeoli and chalazia.
The ideal treatment would include diet modification, increased exercise and resolution of obesity, but management of childhood obesity is complex and outside the purvey of most ophthalmologists. Because nearly all children in the U.S. are under the care of a pediatrician or family physician, most of us will delegate this potentially life-saving treatment to them. We can, of course, give encouragement.
Treatment of blepharitis has been discussed in my commentaries before and is well discussed in the accompanying cover story. I will add just a few thoughts.
Avenova (NovaBay) sprayed on the eye and lids at least twice daily is fairly easy to initiate in children, is safe and can be effective. Omega-3 supplements are also helpful. Most studies show eating breakfast is important in the treatment of obesity, and flaxseed added to breakfast cereal can serve to improve the omega-3 to omega-6 ratio. This is sometimes easier than capsules, liquid omega-3 supplements or gummies. Heat can still be helpful, and most children will tolerate a Bruder mask. Azithromycin 1% topical in difficult cases systemically can be safe and effective. I personally do not use tetracycline compounds in children.
- Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, December 10, 2016.