Treating young patients
The multifactorial nature of dry eye requires consideration of inflammatory and obstructive components, the impact of blepharitis, and the patients’ biofilm.
Foundational treatment begins with good lid hygiene, and young children can benefit from learning and establishing proper hygiene routines with gentle products. Any patient presenting with blepharitis should establish a regimen with a product such as HypoChrlo hypochlorous lid wipes (OCuSOFT) and perhaps warm compresses such as a Bruder mask.
Additionally, I often prescribe the use of artificial tears, such as Refresh Relieva (Allergan). Drop instillation tends to provoke a visceral response in patients of every age, and especially young patients. Therefore, it is very important to avoid creating a negative experience for both parents and child because parent don’t want to wrestle their children at every dosing. A positive association means compliance is far more likely.
I recommend pediatric patients lay down flat, get comfortable, and close their eyes like they are sleeping. With the eyes closed, drop the medication right at the lateral canthus, then ask patients to open the eyes to allow the tear to roll in. This is a nonthreatening process, and children usually feel immediate soothing effects and develop a positive association with drop instillation.
The nutrition factor
As an optometrist, I approach nutrition from a reinforcing perspective. I keep the discussion simple and conversational by asking my patients if they think they have a perfect diet (this usually gets a laugh from parents).
I then explain that nobody can have a perfect diet, and that some of the nutrients we need are not consumed in the typical diet, such as plant-based black currant seed oil. However, we can provide our body with needed nutrients that will potentially manage the symptoms and prevent irreversible damage with high-quality supplements, such as HydroEye (ScienceBased Health) which has demonstrated efficacy in improving dry eye symptoms, EyePromise EZ Tears (ZeaVision), BioTears (BioSyntrx), and others.2,3
Supplemental omega fatty acids have been shown to reduce inflammation and improve the overall quality of tears. There is a growing body of evidence that shows that the omega-6 gamma-linolenic acid (GLA) is highly effective for treating patients with dry eye.4 When combined with omega-3 fatty acids, such as eicosapentaenoic acid (EPA), they decrease pro-inflammatory arachidonic acid and prostaglandin E2.5,6
A randomized, placebo-controlled study shows that nutritional supplements containing EPA and GLA reduce inflammatory biomarkers, improve corneal surface smoothness, and improves symptoms of dry eye.2
Although swallowing a pill may be difficult for very young patients, it is quite feasible for children in their tweens and teens. In addition, I have found that the young adult population is generally open to and even seeking natural methods for treating pathology.
By the time children are able to swallow a supplement, they have usually reached the size of a small adult, so I keep the dosing as recommended by the manufacturer. While not all patients immediately jump on board with nutraceuticals, at least they are made aware that there is a nutrition-based approach to treating dry eye if they wish to pursue it in the future.
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.