Ask the right questions
Asking the right questions to get the right answers is essential to helping younger patients articulate their symptoms. Young children simply have not developed the awareness or vocabulary to tell us how they feel, and tweens and teens may not understand that they can discuss anything outside of glasses and contacts with their optometrist.
General questions may be enough to get the conversation going, such as:
• Do your eyes feel dry?
• Do your eyes get red?
• Do you rub your eyes a lot?
• How much time do you spend looking at screens?
Ultimately, questions should shed light on the effect of accommodation to the visual system.
For pediatric patients, the questions should extend to the parents. A personal or family history of atopy (particularly with an element of eczema), rheumatological conditions, and autoimmune disease are triggers to ask about.
Regardless of the patients’ age, looking for dry eye signs from a clinical perspective appears much the same from behind the microscope.
In my experience, children and teens are generally tolerant of quick and painless testing, such as osmolarity or meibography, so go ahead and run these tests.
The screen factor
Everyone has heard that environment is to blame for virtually everything, and dry eye is likely just one more negative environmental manifestation—specifically the exponential increase of screen time for Americans of every age.
Starting in infancy, children gravitate to the glowing screen in their parents’ hands; school-aged children are required to study and complete assignments online; and adults shop, socialize, and work using their beloved screens. Add in entertainment, and the hours people spend in front of a screen are staggering. It is not a surprise that current research suggest that screen time may play a significant role in dry eye.1
While it is easy to say that adults should monitor and limit screen time for children (there’s an app for that!), ODs must also accept that screens are a necessary part of the world they live in. Realistically, ODs are unlikely to convince their patients to significantly reduce their use of screens; however, educating them on the possible effects of screen time, such as reduced or incomplete blinking, is a great place to start.
I like to teach the 20-20-20 rule: Every 20 minutes, screen users should look up for 20 seconds and focus on an object at least 20 feet away.
In addition, we can remind patients to make a conscious effort to blink completely and simply open and close their eyes throughout the day.
1. Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study. BMC Ophthalmol. 2016 Oct 28;16(1):188.
2. Sheppard, JD, Singh R, McClellan A, Weikert MP, Scoper SV, Joly TJ, Whitley WO, Kakkar E, Pflugfelder SC. Long-term Supplementation With n-6 and n-3 PUFAs Improves Moderate-to-Severe Keratoconjunctivitis Sicca: A Randomized Double-Blind Clinical Trial. Cornea. 2013 Oct;32(10):1297-304.
3. Oleñik A, Jiménez-Alfaro I, Alejandre-Alba N, Mahillo-Fernández I. A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction. Clin Interv Aging. 2013;8:1133-1138.
4. Creuzot-Garcher C, Baudouin C, Labetoulle M, Pisella PJ, Mouriaux F, Meddeb-Ouertani A, El Matri L, Khairallah M, Brignole-Baudouin F. [Efficacy assessment of Nurtilarm, a per os omega-3 and omega-6 PUFA dietary formulation versus placebo in patients with bilateral treated moderate dry eye syndrome.] J Fr Ophtalmol. 2011 Sep;34(7):448-55.
5. Barham JB, Edens MS, Fonteh AN, Johnson MM, Easter L, Chilton FH. Addition of eicosapentainoic acid to gamma-linolenic acid-supplemented diets prevents serum arachidonic acid accumulation in humans. J Nutr. 2000 Aug;130(8):1925-1931.
6. Viau S, Leclère L, Buteau B, et al. Polyunsaturated fatty acids induce modification in the lipid composition and the prostaglandin production of the conjunctival epithelium cells. Graefes Arch Clin Exp Ophthalmol. 2012 Feb;250(2):211-222.
7. National Eye Institute. Facts About the Cornea and Corneal Disease. Available at: https://nei.nih.gov/health/cornealdisease. Accessed 7/30/19.