Condition of the ocular surface system in children with refractive errors
Authors:   S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation, Plisov I.L. , Naumova E.M. ,   Eye Microsurgery Center, Ekaterinburg, Russian Federation
Published: August 2023

Purpose. To evaluate subjective signs and objective clinical symptoms of disorders of the ocular surface system in children with refractive errors. Material and methods. 76 children (152 eyes) with ametropia aged 8 to 18 years were examined. All patients were divided into 2 groups: group 1 – 30 patients aged 8 to 11 years, group 2 – 46 patients aged 12 to 18 years. The severity of the subjective signs of the "dry eye" syndrome and the state of visual comfort were assessed using an online survey developed by the authors. Objectively, the state of the ocular surface system was examined by invasive methods (Schirmer I test, Schirmer II test, Norn test), as well as non-invasive methods using a keratograph (non-invasive tear breakup time, tear meniscus height, meibography, assessment of the severity of hyperemia of the bulbar conjunctiva). In 20 patients (40 eyes) osmometry of the lower lacrimal meniscus was performed. Results. According to a survey of 76 patients, 34 patients (44.7%) had minor disorders of the ocular surface system, 25 patients (32.9%) had moderate disorders, 7 patients (9.2%) had severe disorders, and 10 patients (13.2%) – significantly severe disorders. The indicators of the main tear secretion in the younger age group differ slightly from the standards, while in the older age group they exceed them by 2 mm, the total tear production in both groups of the study was slightly lower than the age standards. The obtained values of reflex tear production are sharply reduced in both study groups, at the age of 12–18 years the deviation is more significant. The average tear film osmolarity in the group of 20 patients aged 12–18 years was 302.75 mOsm/l, which corresponds with adult standards, however, in 6 patients from this group, the values exceeded the standards up to 332 mOsm/l, which is typical for moderate severity dry eye syndrome. It has been established that the indicators of tear film stability measured by both invasive and non-contact methods have similar values. In the group of children from 12 to 18 years old, the indicators are at the lower limit of the norm, however, the spread of the results indicates that there were patients with reduced indicators in the group. The number of eyes with loss of meibomian glands ducts of the 1st degree in the group of children aged 12–18 years was 31.5%, while in the younger group it was 26.7%. A mixed injection of the conjunctiva in the form of hyperemia of the 2nddegree was observed in 10.8% of the eyes in the older group, while in the other group only in 3.4% of the eyes. If more significant subjective chnges were detected, in combination with a deviation from the norms in clinical trials, it was advisable to prescribe age-appropriate drug therapy to patients to correct these conditions. Conclusion. When evaluating the subjective signs of a disorder of the state of the ocular surface system in children, special attention should be paid to the procedure for collecting an anamnesis and quantitative assessment of symptoms. Even in the absence of complaints, it is necessary to conduct an objective, preferably non-invasive study of the stability of the tear film, the state of the meibomian glands, and, if necessary, tear production. When a complex of subjective signs of moderate severity is detected, it is necessary to conduct an explanatory conversation with patients and their parents, paying attention to the aspects of eliminating risk factors for the development of disorders of the ocular surface system. Key words: ocular surface system, tear secretion, tear film stability, meibography