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How Dry Eye Affects Children and Ways to Decrease Risk

Classic symptoms that many adults experience are not as commonly reported by children, says dry eye specialist Kaleb Abbott, OD, MS, FAAO, but learning the signs of pediatric dry eye can be important for life long eye health.

4 minute read

by Kara Mason | January 28, 2025
Young girl sitting in front of a computer. Her glasses are on top of her head, she is holding her eyes.

While dry eye is often considered a disease of adults, it can also manifest in children.

Researchers estimate that around 344 million people across the globe have dry eye, which include symptoms of burning, stinging, redness, foreign body sensation, or feeling a general “grittiness” in the eyes. In children, unaddressed dry eye may worsen dry eye in the long-term.

Dry eye specialist Kaleb Abbott, OD, MS, FAAO,  assistant professor of ophthalmology at the University of Colorado School of Medicine, shares some of the risk factors, symptoms, and treatment options parents should be aware of with dry eye in children.

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How does dry eye manifest differently in children compared to adults?

While the symptoms of dry eye are generally similar, children are less likely to report symptoms such as burning, grittiness, and excessive tearing. However, we are increasingly observing signs of dry eye in children, including corneal staining, which indicates tissue damage on the surface of the eye, and atrophy of the meibomian glands. These glands are responsible for secreting the lipid layer of the tear film, which helps prevent tear evaporation.

Why might children not notice the symptoms like an adult does?

Children often report fewer symptoms of dry eye. This may be due to their compensatory mechanisms that lessen the perception of discomfort. Additionally, the longer someone experiences dry eye, the more damage can occur to the ocular surface, meibomian glands, and corneal nerves, thus worsening symptoms. This prolonged damage may also sensitize the nerves, potentially leading to increased symptoms in adults.

Are there long-term implications for children who experience dry eye early on in life?

The primary concern is that various risk factors can lead to atrophy of the meibomian glands, which, as far as we know, do not regenerate. Consequently, if these glands atrophy at an early age, these individuals may develop severe dry eye later in life.

A recent study showed that about one-third of children have severe atrophy of their meibomian glands.

What are the risk factors for dry eye in children?

Right now, research suggests that between 5.5% and 23.1% of children suffer from dry eye, and like adults, pediatric dry eye increases with age.

The largest study that I've seen shows that the average age of diagnosis for pediatric dry eye is 12. Risk factors for pediatric dry eye include living in an urban environment, use of smartphones and screens, wearing contact lenses, refractive errors (glasses prescriptions), reduced outdoor activity, less sunlight, and high body mass index. Factors associated with pediatric meibomian gland atrophy include time spent outdoors, unhealthy diet, and high body mass index.

If children aren’t reporting symptoms in the same way that adults are, what signs should parents be looking out for?

Parents should first understand the risk factors for dry eye and take steps to keep their children at low risk. If kids wear contact lenses, spend less time outdoors, or have an unhealthy diet, their risk may increase. To help mitigate this, parents can encourage more outdoor play, reduce screen time, use contact lens-compatible artificial tears when wearing contacts, and promote a well-balanced diet.

If these risk factors are present, it’s a good idea to discuss them with your child’s eye doctor during their annual exam.

Are there treatment options for children with dry eye?

Initially, treatment should focus on reducing risk factors. After that, treatment should progress to the use of preservative free artificial tears from a trusted name-brand company.

Unfortunately, the most commonly prescribed dry eye medications have not been extensively studied in children. While we have no current evidence suggesting they are unsafe, we also lack supporting evidence for their use in this age group.

What kinds of research would be beneficial to these patients and their eye doctors?

I would like to see longitudinal studies that follow children over time to identify early signs and symptoms that may signal potential issues in adulthood.

I would also like to see more normative data regarding the expected levels of meibomian gland atrophy. While we know that atrophy occurs in children, we don’t have a clear understanding of what levels are considered normal. The lack of historical data from 30 years ago, before smartphone use became prevalent, makes it difficult to assess the true impact of meibomian gland atrophy.

Finally, it is essential to conduct studies to ensure that the prescription options used in adults are safe and effective for children, allowing us to better manage their symptoms when necessary.

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Kaleb Abbott, OD, MS, FAAO