Evaluation of dry eyes in children with vernal kerato-conjunctivitis using clinical tests and ocular surface analysis

Abstract

Purpose: To evaluate dry eyes in children with vernal kerato-conjunctivitis (VKC) and correlate it with symptoms, clinical findings, and ocular surface analysis (OSA) parameters. Methods: Children with clinically diagnosed VKC underwent complete ophthalmological examination, Schirmer’s testing, modified ocular surface disease index (OSDI) scoring, Bonini grading, fluorescein tear-film break-up time (TBUT), VKC – Collaborative Longitudinal Evaluation of Keratoconus (CLEK) scoring, and OSA. Children with a TBUT of < 10 s were defined to have dry eyes. The above-mentioned parameters were compared between dry eye and non-dry eye VKC children. Results: The mean age of the 87 children included in the study was 9.1 ± 2.9 years. Dry eyes were seen in 60.9% [95% confidence interval (CI); 51% to 71%]. The mean TBUT was 13.4 ± 3.8 and 5.9 ± 1.9 s in non-dry and dry eye groups, respectively (P < 0.001). The mean value of Schirmer’s test was 25.9 ± 9.8 and 20.8 ± 8.6 mm in the non-dry and dry eye groups, respectively (P = 0.01). The two groups did not differ in their OSDI scores, Bonini grading, and CLEK scores. The OSA parameter of non-invasive break-up time (NIBUT) was 8.3 ± 3.2 s in non-dry eye group and 6.4 ± 2.9 s in dry eye group, P = 0.008. The lower lid Meibomian gland (MG) loss was 7.4% in non-dry eye group and 12.2% in dry eye group, P = 0.028. Other OSA parameters did not differ significantly among the two groups. Conclusion: Dry eyes are seen in two-thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation. Among OSA parameters, NIBUT and lower lid MG loss are associated with dry eyes in pediatric VKC patients.

Vernal Keratoconjunctivitis: A Systematic Review

“…Limbal VKC was the most common presentation found in 61.5% of the patients High Syed et al [ 69 ] 2022 Malaysia 4 9.7 To identify the miRNA expression profile in the tears of children with VKC vs controls A total of 51 miRNAs were differentially expressed in the tears of children with VKC. Of the 51 miRNAs, 48 were significantly upregulated, while 3 miRNAs were significantly downregulated High Albadawi et al [ 70 ] 2023 Egypt 71 8.1 To evaluate the corneal epithelial thickness by anterior segment OCT in children with VKC Corneal epithelial thickness mapping showed significant superior thinning (51.07 ± 4.11) μm in VKC group compared to healthy controls (52.54 ± 2.01) μm ( p = 0.008) High Csorba et al [ 71 ] 2023 Hungary 20 N/A To investigate the morphological characteristics of corneal microstructure in the quiescent phase of VKC Langerhans cell density, morphology, and field area were significantly higher in the VKC group than in healthy controls ( p = 0.005, p < 0.001, and p < 0.001, respectively) High Dubbaka et al [ 72 ] 2023 India 152 11.4 To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with VKC PLP was present in 81 cases (53.29%; p < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants High Gupta et al [ 73 ] 2023 India 87 9.1 To evaluate dry eyes in children with VKC Dry eyes are seen in two-thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation <...…”