Primary and pre-op care can help the millions of young patients with DED
Although the prevalence of dry eye disease (DED) increases with age, its relationship isn’t exactly linear as the condition affects a significant portion of the population (1). This includes children and teens, 5.5 percent to 23.1 percent of whom have DED (2). Thus, regardless of age, it is essential to screen every patient for dry eye disease. Timely diagnosis, evaluation, and intervention are essential for primary care, as well as to prepare the ocular surface for surgery, the outcomes of which may be altered by refractive changes and other symptoms related to an unstable tear film.
Omnipresent screens, contact lenses, and other factors
I have diagnosed DED in patients as young as seven years old, as well as many teens and young adult college students. Extensive screen use (digital eye strain) is a major contributor (3). Most children under age eight exceed the established screen time recommendations for their ages (4), and teens average 4.8 hours per day on social media, in addition to school laptops and TV (5). It is not surprising, then, that a study of school children (mean age 12) showed 97 percent had at least one symptom of digital eye strain or dryness, most commonly eyelid heaviness (80 percent) and eye redness (69 percent) (6).
DED is also common in young contact lens wearers (3). Many other health, behavioral, and lifestyle factors contribute to the unexpectedly high rate of DED in this population, including poor sleep quality, allergies, smoking, medications (isotretinoin, oral contraceptives, antidepressants, oral antihistamines), poor diet or hydration, and environmental challenges (wind, very low humidity, air conditioning).
Treatments and modifications
Most young people are not accustomed to hearing they have a chronic condition. I keep the explanation simple and share images of their eyes so they can visualize the problem. To ensure that patients and parents follow my specific recommendations for therapy, I offer easy access to the products they need in the practice, as well as written instructions with QR codes for acquiring them online.
Healthy young people have a high capacity to respond to DED therapies and can often benefit from basic treatments and simple lifestyle changes.
I also want young people to do eyelid hygiene every night; makeup removers, for example, can have ingredients that exacerbate DED. I recommend specific DED-friendly eyelid cleansers, such as iVIZIA micellar eyelid cleansing wipes, OCuSOFT Lid Scrub Plus foaming eyelid cleanser, or a variety of hypochlorous acid sprays.
We also discuss the importance of drinking water and getting plenty of sleep. Nutritional supplements such as Omega fatty acids are quite beneficial. In younger patients, I’m inclined to see if lifestyle modification factors such as eyelid hygiene, artificial tears, breaks on digital devices, adequate hydration, and sleep would work before adding another product to their regimen.
Many of my young patients who experience headaches and digital eye strain find relief after receiving an updated prescription and addressing their DED symptoms. It is critical to ensure that young patients continue to have regular dilated eye exams for evaluating ocular health, maintaining optimal vision, and managing DED.
A 19-Year-Old College Student’s First Eye Exam
A 19-year-old patient came to me for her first ever eye exam because her distance and near vision were decreasing. She experienced eye strain when using the computer, which she did 8 hours per day. She did not complain of DED symptoms, yet her score on the OSDI questionnaire was 14 (mild DED). The patient had no relevant medical history, used no oral or topical medications, and had no known drug allergies.
Without correction, her vision was OD 20/20-1, OS 20/20-1. Refraction was plano OD/OS, and entrance testing was normal. Slit lamp examination revealed that the patient had 2+ MGD, no conjunctival injection, no corneal staining, oily tear film, and a six-second tear breakup time. The posterior segment examination was normal.
I concluded that the patient had mild DED and MGD, with blurry vision due to an unstable tear film. We discussed the importance of tear film homeostasis and how the patient’s screen habits were contributing to chronic DED. We discussed the 20-20-20 rule for digital devices. I suggested using iVIZIA micellar eyelid cleansing wipes, prescribed perfluorohexyloctane (Miebo, Bausch & Lomb) four times a day, and iVIZIA artificial tears as needed. When the patient returned one month later, her eyes were feeling better, she was no longer having vision problems, and she had less eye strain with computer work. Her tear film quality and MGD were improved in each eye, and TBUT improved to 9 seconds. I advised her to continue her current regimen.
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