Management of dry eye related to systemic diseases in childhood and longterm follow‐up

Abstract

ABSTRACT.Purpose: Dry eye in children is not common in general practice and is usually referred to tertiary centres for diagnostic confirmation. In the present review we examine the potential causes of dry eye in children and report the management and longterm follow-up of dry eye in childhood with reference to clinical diversity, systemic associations, ocular outcomes and treatment trends. Methods: A retrospective, consecutive case series was studied by evaluating the clinical charts of children with dry eye over a 96-month period. Minimal diagnostic inclusion criteria were presence of ocular surface damage and tear deficiency. Results: Fourteen patients with an age range at presentation of 1)17 years were evaluated. Ten patients were female, four were male and all had bilateral involvement. The most frequent symptoms were red eye, photophobia and low visual acuity (VA). Four patients had corneal ulcers. Two patients had best corrected visual acuity (BCVA) £ 20 ⁄ 200 at first examination. One of these plus another patient presented with BCVA £ 20 ⁄ 200 at the last visit. All patients were treated with artificial tears; three received autologous serum tears and five submitted to conjunctival flaps to preserve the integrity of the eye. Associated systemic conditions were found in all patients and were congenital in six of them. Conclusions: Early manifestations of dry eye in childhood are a potential indication of systemic disease. The ocular condition may be misdiagnosed and correct treatment delayed. Most diseases are bilateral and may jeopardize VA. Systemic investigation, close follow-up and preparing the family for longterm and multidisciplinary treatment are necessary to preserve ocular health and identify systemic associations.

The use of punctal plugs in children

“…Dry eye severe enough to cause ocular surface damage in children is rare, with little evidence available for treatment strategies 2 6 7…”

“…In fact, in some of the children it was the ophthalmic examination that prompted a systemic evaluation and lead to the underlying diagnosis. In one other published report of dry eye in children, all 14 children had a concurrent systemic disease 2. It is advisable, therefore, for a child presenting with persisting signs or symptoms of dry eye syndrome to have a full paediatric history and clinical examination, so as to reveal or exclude a concurrent systemic condition.…”

“…Other therapeutic approaches are scarce but have been used 2 6. One study looked at the management and follow-up of dry eye in 14 children between the ages of 1 and 17 years with the use of artificial tears 2.…”

“…One study looked at the management and follow-up of dry eye in 14 children between the ages of 1 and 17 years with the use of artificial tears 2. Fourteen per cent developed corneal ulcers and 28% required conjunctival flap treatment with a mean follow-up time of 4 years.…”

Dry-eye syndrome after allogeneic stem-cell transplantation in children

“…We are not aware of other studies that have reported the incidence of subjective complaints among SCT children. On the contrary, it has been suggested that DES questionnaires are less effective in paediatric patients (Mac Cord Medina et al 2007). …”