My child’s eyes are dry and sore

Chapter 98 My child’s eyes are dry and sore


The eye is protected against damage and infection by the lids and by a lubricating tear film. The tear film consists of three layers: mucous (produced by conjunctival goblet cells), aqueous (secreted by the lacrimal glands), and lipid (secreted by the meibomian glands). Dysfunction in any layer of the tear film can result in ocular surface drying and damage. Dry eye disease may be categorized as either aqueous deficient (caused by disorders affecting the lacrimal gland) or evaporative (due to meibomian gland dysfunction or abnormalities of the lid, lid closure and globe leading to exposure).1 Ocular dryness results in increased osmolarity of the tear film and inflammation of the ocular surface. The presence of corneal anesthesia exacerbates the effects of drying and exposure and puts the eye at risk of defective epithelial healing, corneal ulceration, and perforation.

Dry eye in childhood is underdiagnosed and whilst a severely dry and ulcerated eye is easily recognized, milder forms may go unrecognized. Many cases of dry eye have a simple and easily identified explanation, e.g. a lid notch or, most commonly, secondary to allergic eye disease. However, a dry eye in childhood may be the sign of a rare, but serious systemic disorder, and the ophthalmologist should be alert to this possibility.2 Tables 98.1 and 98.2 give details of ocular and systemic diseases/conditions associated with dry eye in children.

Table 98.1 Ocular disease causing dry eye

Allergic eye disease Papillae, giant papillae, corneal erosions
Anesthetic cornea from corneal disease Damage to trigeminal nerve, e.g. herpes simplex, herpes zoster
Aniridia Abnormal tear film stability and meibomian gland dysfunction
Chemical burns Conjunctival scarring
Congenital alacrima Primary form limited to lacrimal gland (also occurs as part of syndromes)
Contact lens wear Reduced tear film volume
Dacryoadenitis Secondary to infection, e.g. Epstein-Barr virus
Incomplete lid closure, proptosis, facial palsy Intensive care patients, VII palsy, shallow orbits, orbital tumors
Lid margin disease Telangiectatic lid margin vessels, scaly debris in lashes, blocked meibomian glands
Lid notch Allows evaporation of tear film
Ocular surface abnormalities Conjunctival scarring (including strabismus surgery), dermolipomas, corneal dellen
Post-ptosis surgery Incomplete lid closure, aggravated by reduced Bell’s or reduced upgaze
Reduced blink rate May be associated with prolonged computer or electronic games use
Topical drug therapy Preservatives can cause conjunctival irritation and dryness

Table 98.2 Systemic disease causing dry eye

Allgrove’s syndrome Triple A syndrome: adrenocorticoid deficiency, achalasia of the cardia, alacrima
Autoimmune polyendocrinopathy syndrome type 1 Reduced tear production, hypoparathyroidism, mucocutaneous candidiasis, adrenocortical insufficiency
Blepharophimosis syndrome Absent lacrimal glands giving alacrima
Chronic renal failure Reduced tear secretion and tear film stability
CIPA: congenital insensitivity to pain with anhidrosis Dry eye, reduced corneal sensivity and ulceration, recurrent fever, anhidrosis, delayed healing
Complete androgen insensitivity syndrome Sex hormone related dry eye may occur before sexual maturation
Craniofacial syndromes Proptosis with exposure
Cystic fibrosis May be vitamin A deficiency or a direct manifestation of cystic fibrosis
Diabetes May relate to autonomic dysfunction
Down’s syndrome Incomplete lid closure is common leading to dry eye
Ectodermal dysplasia Anomalies include ectrodactyly, defects of hair, teeth and sweat glands, cleft lip and palate
Environmental factors Heating, low humidity, air-conditioning, extensive computer use
Epidermolysis bullosa Skin and mucous membrane disease with conjunctival scarring
Goldenhar’s syndrome Dermolipomas, epibulbar dermoids
Graft-versus-host disease Common after pediatric bone marrow transplantation
HIV Lacrimal gland infiltration
Juvenile dermatomyositis Dry eye reported in dermatomyositis and secondary Sjögren’s syndrome
Juvenile idiopathic arthritis Reduced basal tear secretion
Juvenile localized scleroderma Particularly form involving face (en coup de sabre)
KID syndrome: keratitis-ichthyosis-deafness Hyperkeratotic skin lesions, sensorineural hearing loss and vascularizing keratitis
LOC: laryngo-onycho-cutaneous syndrome Ocular granulation tissue with progressive scarring of conjunctiva and cornea
Medication Antihistamines, antispasmodics, retinoids, topical drugs containing preservatives
Möbius’ syndrome Reduced blinking with facial weakness
Multiple endocrine neoplasia type IIB Marfanoid appearance, thick lips and eyelid neuromas, may have prominent corneal nerves
Neuroparalytic keratitis Trigeminal nerve damage: acoustic neuroma, pontine tumors, Goldenhar syndrome, leprosy, after trauma
Pierre Robin sequence May be associated with congenital alacrima
Post-orbital radiotherapy Lacrimal gland damage
Riley-Day syndrome Affects autonomic and sensory nervous system with dry, anesthetic eye
Sjögren’s syndrome Lacrimal gland infiltration producing aqueous deficiency
Stevens-Johnson syndrome Blisters or pseudomembrane in the early stages, later scarring and symblepharon
Trachoma Common in developing world, mucopurulent conjunctivitis then cicatrization and corneal scarring
Turner’s syndrome May relate to hormonal effect on meibomian gland function
Vitamin A deficiency After bowel surgery, restricted diet, cystic fibrosis, dry conjunctiva, Bitot’s spots, keratomalacia, night blindness
Xeroderma pigmentosum Dry pigmented skin, photophobia, reduced tearing, ocular surface squamous neoplasia

Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on My child’s eyes are dry and sore

Full access? Get Clinical Tree

Get Clinical Tree app for offline access