Eyeworld

82 | EYEWORLD | APRIL 2022 C ORNEA by Ellen Stodola Editorial Co-Director About the physicians Preeya K. Gupta, MD Triangle Eye Consultants Durham, North Carolina Gerami Seitzman, MD Medical Director Francis I. Proctor Foundation for Research in Ophthalmology University of California, San Francisco San Francisco, California patients are presenting younger and younger to us," she said. Those in their late teens present- ing with MGD may or may not be symptomatic, but over time, they do become symptomatic. "The prevalence is likely higher than we recog- nize," she said. Dr. Gupta added that part of the problem, and perhaps why these patients are not being diagnosed as often, is because "at the age of the population, we rely on them to have some sort of symptoms." Since these patients are not nec- essarily coming in for routine vision screening, it may be hard to catch. "We do know that MGD can often be asymptomatic in its early phases, so that might contribute to some of the lack of information out there," she said. In terms of diagnosis, Dr. Gupta said that clinicians can see MGD by looking at the mei- bomian glands and the quality of oil coming out of the glands. "But we can also be screening patients by assessing for symptoms," she said. "Sometimes they don't attribute symptoms they're having to a diagnosis like MGD." These can include fluctuating vision, eye fatigue, or irritation. Rosacea can happen when facial sebaceous glands become inflamed, Dr. Seitzman said. "Meibomian glands on the lids are sebaceous glands; when they are inflamed patients can be diagnosed with ocular rosacea," she said. The pediatric population can also be afflict- ed with ocular rosacea. Rosacea is commonly thought of in patients with pale skin as the in- flammatory changes on their skin appear quite red. However, rosacea can happen in patients with any skin color. "Rosacea and ocular rosa- cea can be misdiagnosed or diagnosed late in children with skin of color, as the blood vessel changes can be more subtle with less contrast," she said. In the pediatric population, Dr. Seitzman said that styes alone or mild dry eye will be uncomfortable but reasonably easy to treat. "However, there is a markedly inflammatory condition of MGD in the pediatric population, similar to ocular rosacea," she said. "This is called chronic blepharokeratoconjunctivitis (BKC) of childhood. Here the lid margin in- flammation spills over to the surface of the eye, and the cornea can become inflamed and even W hile it's hard to determine the incidence of meibomian gland dysfunction (MGD) in children, it can be a serious issue in this population. Preeya K. Gupta, MD, and Gerami Seitzman, MD, discussed MGD in pediatric patients and what to look for. Dr. Seitzman said that the incidence of MGD in children is not well described. Clogged meibomian glands can be a cause of dry eye in children, and they can also cause bumps in the eyelids (styes or chalazia). Dr. Seitzman noted that MGD can often be overlooked in the younger patient population because many children are not examined at the slit lamp, which is required to assess meibomian health. Also, chronic recurrent red eyes can be incorrectly attributed to "just pink eye" in this school-age population, she added. Dr. Gupta also said that it's hard to find published data and prevalence of MGD in children, but MGD in this population definitely exists. "What we're noticing clinically is that MGD in the pediatric population Slit lamp photo of 8-year-old girl, right eye; marked lid margin inflammation, upper eyelid greater than lower with clogged meibomian glands; marked conjunctivitis and peripheral keratitis

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