Background: Dry eye is a disease condition wherein the ocular surface is either not uniformly or not completely lubricated by tear film. Dry eye is less prevalent in children, but if observed it may be a manifestation of conditions like Steven Jonson syndrome, Sjogren’s syndrome, blepharitis, MGD or VKC. Therefore, evaluation of dry eye may aid in effective and timely treatment of other life-threatening diseases in children. Aim of current study was determination of dry eye in pediatrics and to investigate its association with ocular surface disorders like MGD, VKC and VDT.Methods: A prospective observational study was conducted on 400 patients. All patients were screened for OSDI and patients having index score >11 were investigated for dry eye disease, based on inter blink interval and tear-film breakup time determined using slit lamp and through Schirmer’s test. Dry eye patients were further investigated to determine type and causative factors for dry eye.Results: 25 patients exhibited bilateral dry eye with >12 score. Children of age group 7-18 years were commonly affected. Diseases commonly observed to be associated with dry eye in children were VKC, MGD, or visual display terminal caused due to over use of smart phone and digital screen.Conclusions: The evaporative dry eye due to MGD and VDT is more common in pediatric age group in comparison to aqueous deficiency dry eye. Overuse of smart phones, tablets or computers increases the prevalence of dry eye which inturn affect their outdoor activity, studies and over all development of children.

Presbyopia is characterized by accommodative loss that leads to negative effects on vision-targeted health-related quality of life. It occurs in people who gradually lose the ability to adapt after the age of 40. Accommodation depends on the contraction of the ciliary muscle and the iris, the change and the convergence of the lens. The parasympathetic nervous system regulates the degree of contraction of the ciliary muscle and the iris necessary to alter the shape and position of the lens, and its stimulation is effective by activating the muscarinic receptors present in both structures. The hypothesis presented here suggests that patients with emmetropic presbyopia correct accommodation with pharmacotherapy that includes a combination of cholinergic drugs and non-steroidal anti-inflammatory drugs (NSAIDs). Topical treatment deals with drug combinations to modify one or more factors involved in the accommodative process and have been proposed to be instilled either monocular/ binocularly. Result shows para-sympathomimetic stimulation of parasympathetic innervation (accommodation) and NSAID: Prolonging the effect of the para-sympathomimetic action and modulates the accommodation. The drug combination restores near vision without affecting distance vision. It is important to note that the drug form used has no inflammatory effects or other side effects. Despite the lack of a completely well understood mechanism, pharmacological control of presbyopia seems to be a possible and very attractive alternative for presbyopia patients. The studies mentioned in this review are to be considered pilot investigations as they involve either a small number of subjects or are single case series.