Dry eye—often caused by meibomian gland dysfunction (MGD)—is more frequent among older patients. However, researchers now believe it may be under-diagnosed and under-treated in young patients, possibly affecting athletic and academic performance in children.

Researchers recently discovered that 15% of study participants exhibited ocular symptoms, and most had mild meibomian gland dropout in one or both eyelids. The latter finding was unexpected, as meibomian gland dropout is thought to increase with age; these adolescents were already experiencing a significant impact.

This cross-sectional study evaluated 225 subjects between the ages of eight and 17. Each participant completed dry eye and lifestyle questionnaires. The team assessed their tear film, performed meibography and analyzed the differences in ocular surface parameters between age groups based on clinical findings and lifestyle factors.

The investigators found that 15% of the patients had ocular discomfort, primarily itching and irritation. They note that tear meniscus height increased with age and was greatest in the oldest subjects. Meibography showed that 39% of the upper and 39% of the lower eyelids had meibomian gland dropout, with average scores of 0.50±0.57 for the upper eyelids and 0.67±0.93 for the lower.

The team found no correlation between device use and meibomian gland dropout for either the upper or lower eyelids—meaning that the effects of long-term digital device use are still unclear. Based on the 27% of patients who had an ocular surface disease index score greater than 12, the study authors determined that one in four subjects should be classified as having dry eye.

“Clinicians should anticipate that approximately one in seven patients in this age range may be experiencing mild symptoms of ocular dryness without classic clinical signs, which could be an indication that the ocular surface system in adolescents is robust enough to compensate,” they noted.

Clinicians should discuss possible symptoms and evaluate meibomian gland function in this patient population to help detect ocular surface disease earlier, the researchers concluded. 

Tichenor AA, Ziemanski JF, Ngo W, et al. Tear film and meibomian gland characteristics in adolescents. Cornea. September 17, 2019. [Epub ahead of print].