Vision Expo 2026: Why pediatric ocular surface health can't be an afterthought, with Sheila Morrison, OD, MS

During her presentation "Dry Eyes & Myopia Management—When Kids Win and Lose" at Vision Expo 2026, held March 11 to 14 in Orlando, Florida, Sheila Morrison, OD, MS, addressed one of the more underappreciated clinical collisions in pediatric eye care: the compounding relationship between dry eye disease (DED) and myopia control therapies, and why practitioners may be the greater barrier to better outcomes—not the patients themselves.¹ Afterward, she connected with the Eye Care Network and Optometry Times to discuss the topic further.

The pediatric dry eye problem is more prevalent than many clinicians might appreciate. A systematic review and meta-analysis published in 2025 found that the clinical prevalence of DED among children reached 16.6% across included studies, with questionnaire-based assessments yielding rates as high as 34.6%.² Meibomian gland dysfunction (MGD) is a well-documented contributor to this picture in young patients, and research from Duke University Eye Center found that 42% of pediatric subjects between the ages of 4 and 17 years had some degree of meibomian gland atrophy on meibography—even among those with no prior history of it or DED.³

Environmental and lifestyle factors are accelerating these trends, which Morrison pointed out. Digital device use has been associated with significant reductions in blink rate and blink completeness in children, with one study finding that excessive screen time was significantly correlated with reduced tear breakup time and lower blink rates, contributing to both DED and inflammatory conjunctivitis in children as young as 3 years.⁴

Into this environment comes the growing demand for myopia management—contact lens–based therapies, atropine drops, and orthokeratology—all of which place additional demands on an ocular surface that may already be compromised. As Morrison explained at Vision Expo 2026, dry eye creates what she describes as "the perfect storm" when it intersects with myopia control: 2 distinct entities that, when they converge, undermine the core elements of therapeutic success—comfort, handling, and lens tolerance. Solutions management, lens wear adherence, and patient-reported comfort are among the most common failure points in myopia control programs, and DED works against all 3.

Yet Morrison's more pointed clinical observation from her presentation is not about the patients—it is about the practitioners. Children, she argues, are actually well-positioned to succeed in these treatment regimens. They are coachable, adaptable, and supported by parents who can serve as active members of the care team. The greater barrier, in her view, is practitioner hesitation: a reluctance to apply dry eye therapies traditionally reserved for adults to a pediatric population or simply a failure to assess for ocular surface disease before initiating myopia management. Examining the lids and lashes, evaluating for underlying inflammatory conditions, and considering the full ocular surface picture before fitting a child into a contact lens or prescribing a drop should be standard—not an afterthought to a crowded myopia control workflow.

The evidence supports her call for earlier, more routine ocular surface assessment in young patients. Researchers have suggested that the presence of meibomian gland atrophy in pediatric populations raises important questions about whether environmental factors are accelerating subclinical gland dysfunction, and that earlier screening and intervention may improve long-term outcomes.³ With meibomian gland structure alterations documented in children as young as 6 years, and with daily smartphone use identified as an independent risk factor for pediatric DED,² the argument for integrating ocular surface evaluation into routine pediatric exams is strong and growing.

Morrison's message from Vision Expo 2026 is ultimately one of clinical recalibration. As myopia continues its global rise and management programs expand into younger patient populations, the ocular surface cannot be treated as a secondary consideration. Identifying and addressing dry eye proactively—before, not after, initiating myopia control therapy—may be among the most impactful steps a practitioner can take to improve both patient adherence and long-term visual outcomes.

References

1. Morrison S. Dry eyes and myopia management - when kids win and lose. Presented at: Vision Expo; March 12, 2026; Orlando, FL. Session 24L1.

2. Zou Y, Li D, Gianni V, et al. Prevalence of dry eye disease among children: a systematic review and meta-analysis. BMJ Open Ophthalmol. 2025;10(1):e002014. doi:10.1136/bmjophth-2024-002014

3. Gupta PK, Stevens MN, Kashyap N, Priestley Y. Prevalence of meibomian gland atrophy in a pediatric population. Cornea. 2018;37(4):426-430. doi:10.1097/ICO.0000000000001476 doi:10.1097/ICO.0000000000001476

4. Shah M, Natarajan SB, Ahmad N. Excessive screen time exposure leads to dry eyes and inflammatory conjunctivitis in children. Ir J Med Sci. 2025;194(2):597-602. doi:10.1007/s11845-025-03920-9