“Hanna is complaining of dry eyes recently. Do you think it’s the OK lens?”

This question comes up frequently. Our practice is devoted to myopia management, and we examine several dozen orthokeratology (OK) patients each week. Dry eye among pediatric patients has been discussed in this column and the following peer-reviewed articles.

One study found a relatively high level of mild meibomian gland atrophy among children not wearing contact lenses (Gupta et al, 2018). In addition, children’s excessive electronic screen use has been associated with meibomian gland atrophy, a finding of particular importance during the pandemic (Cremers et al, 2021). Determining the etiology of the dry eye is often compounded when a child wears orthokeratology lenses, because it is unclear whether OK contributes to or alleviates dry eye (Na et al, 2016).

Steps to Take

When we receive a complaint like the one outlined above, here are some steps to alleviate the patient’s symptoms.

Perform the Exam Perform a detailed biomicroscopic examination, with and without lenses in place. Evaluate the cornea for signs of superficial punctate keratitis. Also evaluate the bulbar conjunctiva to detect signs of epithelial disturbance or loss.

• Action When a contributing lens issue is detected, make the necessary adjustments to the lens design and reevaluate the child after he or she has worn the new lenses for a few weeks. Also, examine the patient’s eyelids for signs of meibomian gland dysfunction.

• Action When this is a contributing factor, carefully instruct the patient and their parents on how to properly heat their eyelids, followed by effective eyelid massage. Additionally, show videos of clogged meibomian glands to the family to help explain treatment recommendations.

Obtain Patient History Determine the possibility of solution sensitivity with a detailed patient history. Does ocular redness accompany the dry eye? Do the eyes feel dry with or without the lenses? Does the patient experience stinging upon instillation of eye drops? Are symptoms present in one or both eyes?

• Action When a preservative sensitivity is suspected, eliminate potential irritants and switch over to preservative-free lubricating eye drops. It’s an option to switch the type of GP lens soaking solution to see whether this alleviates the patient’s symptoms.

Review the patient’s contact lens routine. Are they placing a lubricating drop in their eyes prior to applying and removing their lenses? Are they using the prescribed solutions?

• Action Reinforce the correct bedtime and morning routines. Ask the patient to soak their lenses in the prescribed GP lens solution prior to applying their lenses to improve lubrication and comfort.

The key to success is follow-up with parents. Reach out prior to their next visit to determine if their child’s system has improved.

Case Summary

The reality is that there may be more than one factor contributing to the complaint of dry eyes.

In Hanna’s case, she was applying her lenses directly from neutralized hydrogen peroxide solution without applying lubricating eye drops. We suspected that her dry eyes stemmed from contact lens-related routine “decay.” We asked her to soak her lenses in rigid GP solution prior to application. We also reiterated the importance of instilling a lubricating eye drop prior to application at night and again upon removal in the morning.

When we followed up with Hanna’s mother one week later via email, her response made us smile:

“I checked with Hanna, she said her eyes are fine now, no issues. She says she just got lazy. We’ll let you know if things change. Thanks for your concern, Hanna’s mom.” CLS

References

1. Gupta PK, Stevens MN, Kashyap N, Priestley Y. Prevalence of meibomian gland atrophy in a pediatric population. Cornea. 2018 Apr;37:426-430.
2. Cremers SL, Khan A, Ahn J, et al. New Indicator of Children’s Excessive Electronic Screen Use and Factors in Meibomian Gland Atrophy. Am J Ophthalmol. 2021 Sep;229:63-70.
3. Na K-S, Yoo Y-S, Hwang HS, Mok JW, Kim HS, Joo C-K. The influence of overnight orthokeratology on ocular surface and meibomian glands in children and adolescents. Eye Contact Lens. 2016 Jan;42:68-73.