Prevalence of DED in children slightly lower than adults, but underdiagnosis ‘conceivable’
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Key takeaways:
- The prevalence of DED in children ranged from 5.5% to 23.1%, with higher rates reported among girls.
- There is little research on the safety and efficacy of DED treatment options in children.
More research is needed to improve diagnosis of dry eye disease in children, as well as to determine the safety and efficacy of treatment options in this population, according to a literature review published in The Ocular Surface.
“Young people with DED appear to experience a similar profile of symptoms to adults, and the impact of DED on quality of life is considerable, with effects on presenteeism, concentration and performance at school and other activities, including reading and playing,” Fiona Stapleton, MSc, PhD, a professor in the School of Optometry and Vision Science at UNSW Sydney, and colleagues wrote.
To assess the prevalence, risk factors and management options for DED in individuals younger than 18 years, researchers conducted a literature search from 2000 to 2002 using PubMed, identifying 54 eligible studies from 2,633 articles.
According to results, the prevalence of DED in children ranged from 5.5% to 23.1%, with one study demonstrating that more girls than boys had a previous diagnosis (8% vs. 4.3%), as well as severe symptoms (24.4% vs. 21%).
Thirty studies suggested risk factors for DED in children. Ocular allergy and underlying systemic disease, including congenital, autoimmune, endocrine and inflammatory disorders, were associated with higher rates of DED, as was female sex, with sex differences more pronounced in older children. Meibomian gland dysfunction was associated with subsequent development of more severe DED.
Daily use of a smartphone was identified as an independent risk factor for DED, though the researchers suggested that overall digital device use could be influenced by indirect but related variables like time spent outdoors, sedentary lifestyle and impaired sleep.
Treatment options for younger patients are comparable to those for adults — lifestyle modifications, blinking, management of lid disease and unpreserved lubricants for mild disease — but there is little research evaluating their safety and efficacy in the pediatric population.
“Development of age-appropriate thresholds for signs and symptoms of DED may support better diagnosis of disease and understanding of the natural history in a young population,” Stapleton and colleagues wrote. “It is conceivable that DED may be underdiagnosed owing to underreporting in children with chronic DED symptoms and the lack of tools designed specifically for the young population.”
Perspective
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Dry eye has been extensively studied in adults, but our understanding of its prevalence, risk factors, comorbidities and optimal treatments in children remains inadequate. There is growing concern that dry eye is underrecognized and underdiagnosed among pediatric patients.
This review found that dry eye prevalence in children ranged from 5.5% to 23.1%, with girls more affected than boys. Independent risk factors included daily screen time, evening screen use, urban living and contact lens wear — particularly pertinent given the increasing use of contact lenses for myopia control in children. Protective factors included rural residence and outdoor activities. Interestingly, studies have shown meibomian gland function and structure alterations in children as young as 6 years.
Although treatments for pediatric dry eye parallel those for adults, the study underscored the lack of sufficient data on the efficacy and safety of common treatments in young populations. Despite our limited understanding, it is crucial for practitioners to recognize the risk factors that predispose children to dry eye.
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