Advertisement

Evaluation of dry eye disease in children with blepharokeratoconjunctivitis

Published:March 16, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.02.017

      Abstract

      Objective

      To evaluate the symptoms and signs of dry eye disease (DED) in children diagnosed with blepharokeratoconjunctivitis (BKC).

      Design

      Prospective case-controlled study

      Participants

      Consecutive patients with BKC and normal controls.

      Methods

      All participants underwent a comprehensive dry eye assessment including the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity test, Schirmer's test without anesthesia, slit lamp examination, tear film break-up time, corneal fluorescein staining (CFS), and lissamine green conjunctival staining (LGCS), according to the Sjögren's International Collaborative Clinical Alliance ocular staining score. For each test the result of the more severe eye was included in the statistical analysis.

      Results

      Twenty-five patients were recruited—11 with BKC and 14 healthy controls. No difference in symptoms was found between children with BKC (CDEA score 6.1 ± 5.5) and normal controls (CDEA score 3.6 ± 3.2; p = 0.16). Children with BKC had significantly higher mean CFS (1.1 ± 1.6 vs 0.1 ± 0.4; p = 0.04) but similar mean LGCS (1.4 ± 1.8 vs 1.5 ± 2.1; p = 0.81) than normal controls. No statistically significant differences were observed in other tests between the 2 groups. CDEA scores were significantly correlated to CFS in normal controls (r = 0.59, p = 0.03), and approached significance in children with BKC (r = 0.56, p = 0.07).

      Conclusions

      The only test that can distinguish DED in patients with BKC from children without BKC is the CFS score. This should guide management and monitoring of this unique patient population with DED symptoms and signs.

      Résumé

      Objectif

      Évaluer les signes et symptômes de la sécheresse oculaire (SO) chez des enfants qui ont reçu un diagnostic de blépharokératoconjonctivite (BKC).

      Nature

      Étude cas-témoins prospective.

      Participants

      Patients consécutifs présentant une BKC et sujets témoins en bonne santé.

      Méthodes

      Tous les participants ont fait l'objet d'une évaluation exhaustive de la SO : questionnaire « Évaluation de la sécheresse oculaire chez les Canadiens » (ESOC), mesure de l'osmolarité du film lacrymal, test de Schirmer sans anesthésie, examen à la lampe à fente, temps de rupture du film lacrymal ainsi que coloration de la cornée à la fluorescéine (CCF) et coloration de la conjonctive au vert de lissamine (CCVL) conformément au score de coloration oculaire du Sjögren's International Collaborative Clinical Alliance. Aux fins de l'analyse statistique, on a inclus le résultat du pire œil pour chacune de ces évaluations.

      Résultats

      Vingt-cinq patients ont été recrutés : 11 sujets qui présentaient une BKC et 14 témoins en bonne santé. Aucune différence n'a été observée quant aux symptômes entre les enfants qui présentaient une BKC (score de 6,1 ± 5,5 sur l'ESOC) et les sujets sains (score de 3,6 ± 3,2 sur l'ESOC; p = 0,16). Les enfants qui présentaient une BKC avaient une CCF moyenne significativement plus élevée (1,1 ± 1,6 vs 0,1 ± 0,4; p = 0,04), mais une CCVL moyenne semblable (1,4 ± 1,8 vs 1,5 ± 2,1; p = 0,81), comparativement aux sujets sains. Les résultats des autres examens n'ont fait ressortir aucune différence statistiquement significative entre les 2 groupes. Le score sur l'ESOC avait une corrélation significative avec la CCF chez les sujets sains (r = 0,59; p = 0,03) et était presque significatif chez les enfants qui présentaient une BKC (r = 0,56; p = 0,07).

      Conclusions

      Le seul examen qui peut distinguer la SO chez les enfants avec BKC versus ceux sans BKC est la CCF. Cet examen peut donc orienter la prise en charge et la surveillance de ce groupe unique de patients qui présentent des signes et des symptômes de SO.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Viswalingam M
        • Rauz S
        • Morlet N
        • Dart JK.
        Blepharokeratoconjunctivitis in children: diagnosis and treatment.
        Br J Ophthalmol. 2005; 89: 400-403
        • Farpour B
        • McClellan KA.
        Diagnosis and management of chronic blepharokeratoconjunctivitis in children.
        J Pediatr Ophthalmol Strabismus. 2001; 38: 207-212
        • Suzuki T
        • Kinoshita S.
        Meibomitis-related keratoconjunctivitis in childhood and adolescence.
        Am J Ophthalmol. 2007; 144 (author reply 1): 160-161
        • Hammersmith KM.
        Blepharokeratoconjunctivitis in children.
        Curr Opin Ophthalmol. 2015; 26: 301-305
        • Gupta N
        • Dhawan A
        • Beri S
        • D'Souza P
        Clinical spectrum of pediatric blepharokeratoconjunctivitis.
        J AAPOS. 2010; 14: 527-529
        • Jones SM
        • Weinstein JM
        • Cumberland P
        • et al.
        Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis.
        Ophthalmology. 2007; 114: 2271-2280
        • Teo L
        • Mehta JS
        • Htoon HM
        • Tan DT.
        Severity of pediatric blepharokeratoconjunctivitis in Asian eyes.
        Am J Ophthalmol. 2012; 153 (564–70 e1)
        • Ong Tone S
        • Elbaz U
        • Silverman E
        • et al.
        Evaluation of dry eye disease in children with systemic lupus erythematosus and healthy controls.
        Cornea. 2019; 38: 581-586
        • Jackson WB.
        Management of dysfunctional tear syndrome: a Canadian consensus.
        Can J Ophthalmol. 2009; 44: 385-394
        • Schiffman RM
        • Christianson MD
        • Jacobsen G
        • et al.
        Reliability and validity of the Ocular Surface Disease Index.
        Arch Ophthalmol. 2000; 118: 615-621
        • Lemp MA
        • Bron AJ
        • Baudouin C
        • et al.
        Tear osmolarity in the diagnosis and management of dry eye disease.
        Am J Ophthalmol. 2011; 151 (792–8 e1)
        • Willcox MDP
        • Argueso P
        • Georgiev GA
        • et al.
        TFOS DEWS II Tear Film Report.
        Ocul Surf. 2017; 15: 366-403
        • Whitcher JP
        • Shiboski CH
        • Shiboski SC
        • et al.
        A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjogren's Syndrome International Registry.
        Am J Ophthalmol. 2010; 149: 405-415
        • Yin Y
        • Gong L.
        The evaluation of meibomian gland function, morphology and related medical history in Asian adult blepharokeratoconjunctivitis patients.
        Acta Ophthalmol. 2017; 95: 634-638
        • Shimazaki J
        • Goto E
        • Ono M
        • et al.
        Meibomian gland dysfunction in patients with Sjogren syndrome.
        Ophthalmology. 1998; 105: 1485-1488
        • Rabensteiner DF
        • Aminfar H
        • Boldin I
        • et al.
        The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population.
        Acta Ophthalmol. 2018; 96: e707-e711
        • Keech A
        • Senchyna M
        • Jones L.
        Impact of time between collection and collection method on human tear fluid osmolarity.
        Curr Eye Res. 2013; 38: 428-436
        • Amparo F
        • Hamrah P
        • Schaumberg DA
        • Dana R.
        The value of tear osmolarity as a metric in evaluating the response to dry eye therapy in the clinic and in clinical trials.
        Am J Ophthalmol. 2014; 157: 915-916
        • Amparo F
        • Jin Y
        • Hamrah P
        • et al.
        What is the value of incorporating tear osmolarity measurement in assessing patient response to therapy in dry eye disease?.
        Am J Ophthalmol. 2014; 157 (69–77 e2)
        • Vu CHV
        • Kawashima M
        • Yamada M
        • et al.
        Influence of meibomian gland dysfunction and friction-related disease on the severity of dry eye.
        Ophthalmology. 2018; 125: 1181-1188
        • Abelson MB
        • Ousler 3rd, GW
        • Nally LA
        • Emory TB.
        Dry eye syndromes: diagnosis, clinical trials and pharmaceutical treatment––'improving clinical trials'.
        Adv Exp Med Biol. 2002; 506: 1079-1086
        • Lemp MA
        • Hamill Jr, JR
        Factors affecting tear film breakup in normal eyes.
        Arch Ophthalmol. 1973; 89: 103-105
        • Al-Hayouti H
        • Daniel M
        • Hingorani M
        • et al.
        Automated ocular surface image analysis and health-related quality of life utility tool to measure blepharokeratoconjunctivitis activity in children.
        Cornea. 2019; 38: 1418-1423
        • Garcia-Hirschfeld J
        • Lopez-Briones LG
        • Belmonte C.
        Neurotrophic influences on corneal epithelial cells.
        Exp Eye Res. 1994; 59: 597-605
        • Ueno H
        • Ferrari G
        • Hattori T
        • et al.
        Dependence of corneal stem/progenitor cells on ocular surface innervation.
        Invest Ophthalmol Vis Sci. 2012; 53: 867-872
        • Ferdousi M
        • Petropoulos IN
        • Kalteniece A
        • et al.
        No relation between the severity of corneal nerve, epithelial, and keratocyte cell morphology with measures of dry eye disease in type 1 diabetes.
        Invest Ophthalmol Vis Sci. 2018; 59: 5525-5530