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DRY EYE

DRY EYES IN CHILDREN Children with dry eyes present with irritable, gritty eyes, which may be diffusely injected. On examination there is a reduced tear meniscus with punctate keratopathy, particularly affecting the interpalpebral zone. Staining occurs with fluorescein dye. Congenital alacrima, or hyposecretion of tears, is rare.This may be due to absence of the lacrimal gland or to the lacrimal gland being ectopic. Alacrima may be associated with systemic conditions such as Allgrove syndrome (familial alacrima, chalasia of the cardia and glucocorticoid deficiency), anhidrotic ectodermal dysplasia and Riley-Day syndrome (familial dysautonomia), Acquired tear insufficiency may be due to pathology of the lacrimal gland, causing failure of tear production, or to conjunctival damage, leading to ductule obliteration. The gland may be damaged by Epstein-Barr infection, as the result of HIV infection, or in patients following bone marrow transplantation (often associated with graft versus host disease). Sjögren's syndrome is rare in children; Acquired tear insuthciency may be due to pathology of the lacrimal gland, causing failure of tear production, or to conjunctival damage, leading to ductule obliteration. The gland may be damaged by Epstein-Barr infection, as the result of HIV infection, or in patients following bone marrow transplantation (often associated with graft versus host disease). Sjögren's syndrome is rare in children; it can be a primary autoimmune event or secondary to rheumatoid arthritis or systemic lupus erythematosus (SLE). Children with Sjögren's syndrome often have lacrimal gland involvement, and they may have recurrent parotid gland swelling and salivary gland involvement. Sjögren's should be considered in any child with recurrent parotitis, keratoconjunctivitis sicca, and early tooth decay due to xerostomia.  Isotretinoin treatment for acne can cause dry eyes in adolescence. This is usually reversible at cessation of the drug. Treatment of dry eyes involves copious use of artificial tears and temporary or permanent punctal occlusion in severe cases.