How to spot dry eye disease in children

‘Doctor, my kid is blinking a lot, and the eye is in pain’. This is one of the commonest complaints I see in my consultation. When should parents be concerned? 

Dry eye disease (DED) is often overlooked in children. This is because children, especially younger ones are not able to communicate fluently. DED can cause these kids to have uncomfortable eyes and sometimes blurry vision.  

Untreated, DED can lead to irregular corneal surface, and potentially cause astigmatism. Astigmatism is commonly due to an abnormal shape of the cornea which can affect the vision. In young children under the age of 7 years old, astigmatism can be complicated by lazy eye (amblyopia). Therefore children with chronic DED need to be examined thoroughly to rule out this potential complication. 

Here are some common warning signs and symptoms of DED in children to help parents detect this problem. 

Signs and symptoms of dry eyes in children

1.    Frequent blinking 
2.    ‘Pain’ in the eye – often children complain of ‘pain’ in the eye which actually translates to discomfort, gritty, foreign body sensation
3.    ‘Headaches’ – heavy feeling or pressure around the eyes
4.    Light sensitivity – dislike of sunlight or brightly lit room
5.    Eye rubbing 
6.    Red eyes and watery eyes

Common causes

1.    Electronic devices - Screen time is becoming a significant risk factor for DED in children
2.    Allergies – increasingly become more common in children. Often these children will also have runny itchy noses (allergic rhinitis) and itchy skin rashes (eczema). 
3.    Meibomian gland disease/ blepharitis – often overlooked or treated as allergic conjunctivitis. These children may also have recurrent lumps and bumps on their eyelids (like styes and chalazia)
4.    Epiblepharon or inturning of eyelashes – a common eyelid condition affecting mainly Asian children. These children suffer from constant rubbing of their eyes from their inturning eyelashes
5.    Contact lens usage and over the counter eyedrops with preservatives
6.    Rarer conditions – autoimmune conditions, severe malnutrition

Prevention methods and treatment 

1.    Reduce screen time
2.    Identify allergens
3.    Review by an eye specialist to rule out underlying treatable eye conditions like allergies, blepharitis, epiblepharon, contact lens-related problems