Dry eye is not common in pediatric patients because a thicker tear film coats the ocular surface in comparison to adults. Nevertheless, children present with dry eye for various reasons, and it is our responsibility to properly diagnose and manage it. This can be challenging because children do not always accurately communicate their dry eye symptoms. This article will review some common causes of dry eye in children.

Digital Devices

It is now common for children to use digital devices for learning and entertainment (Figure 1). Digital device use for long hours is associated with a decreased blink rate and subsequent dry eye symptoms.

Figure 1. Children are now spending more time using digital devices, which can cause dry eye symptoms if overused.

Remedies for technology-based dry eyes in children include limiting the time spent in front of digital devices, playing outside for entertainment, and using artificial tears (Moon et al, 2016).

Ocular Allergies

Children who have dry eye symptoms often have signs of allergic conjunctivitis. Goblet cell instability and decreased tear breakup time in allergic conjunctivitis cause an upregulation in inflammatory factors that affects the tear balance. Treating allergic conjunctivitis can help with dry eye symptoms in children (Akil et al, 2015).

Autoimmune Disease

Juvenile-onset autoimmune diseases such as type I diabetes mellitus and rheumatoid arthritis (RA) are associated with dry eye. Reflex tear secretion is altered in diabetics due to corneal sensory neuropathy and microvascular damage of the lacrimal gland (Akil et al, 2016). Aqueous deficient dry eye is the most common ocular complication in adult RA and is also found in pediatric patients (Akinci et al, 2007).

Ocular Rosacea

Adult acne rosacea includes facial erythema, flushing, telangiectasia, and pustule formation. Children do not have the rhinophyma found in adults; however, both share the same ocular manifestations. Suspect ocular rosacea in children who have chronic blepharitis, meibomian gland dysfunction, chalazia, conjunctival hyperemia, corneal subepithelial infiltrates, and punctate epitheliopathy and peripheral vascularization of the inferior cornea.

The treatment for ocular rosacea in children is similar to that for adults and includes lid hygiene, artificial tears, and oral antibiotics. Tetracycline can accumulate in growing bone and can retard enamel development and cause color changes in the teeth. Therefore, oral tetracycline is contraindicated in cases younger than nine years of age (Donaldson et al, 2007).

Vitamin A Deficiency

Ocular manifestations of vitamin A deficiency include xerosis and night blindness. Pathognomonic Bitot’s spots, which are composed of scaled-off keratin mixed with gas-forming bacteria, may also occur, generally at the temporal limbus. In severe disease, corneal ulceration and melting may occur. Hypovitaminosis A should be considered in children who present with dry eye complaints (Faustino et al, 2016).


Although uncommon in children, being aware of the different causes of pediatric dry eye will help better serve this population. CLS

For references, please visit and click on document #257.