Eyeworld

APRIL 2022 | EYEWORLD | 83 C Contact Gupta: pgupta@TriangleEyeNC.com Seitzman: Gerami.Seitzman@ucsf.edu References 1. Gupta PK, et al. Prevalence of meibomian gland atrophy in a pediatric population. Cornea. 2018;37:426–430. 2. Gupta PK, et al. Association of meibomian gland architec- ture and body mass index in a pediatric population. Ocul Surf. 2020;18:657–662. Relevant disclosures Gupta: Alcon, Johnson & Johnson Vision, Sight Sciences Seitzman: None Examination under anesthesia of 10-year-old girl, right eye; marked meibomian gland inspissation, lid margin inflammation, and conjunctivitis; old corneal scars and active areas of corneal epithelial breakdown and ulceration Source (all): Gerami Seitzman, MD infected." When corneal involvement occurs, this is typically very painful and places children at risk of vision loss. Dr. Seitzman said that any child with chron- ic recurrent red eyes, especially with photopho- bia and/or vision loss, should be evaluated by an ophthalmologist familiar with diagnosis and management of MGD in children and BKC in general. MGD has the potential to be a long-term issue for these patients. If it's not diagnosed and addressed in the early stages, many years of inflammation can cause damage to the glands and eventually meibomian gland atrophy, Dr. Gupta said. Once you get to the point of atrophy or actual loss of meibomian gland tissue, the glands can't be restored. Dr. Gupta stressed the importance of mei- bography or meibomian gland imaging, which will indicate what the health of the glands are and whether there has been gland loss. "Some- times we're surprised by how much atrophy is present on meibography, and that can give us clues as to how significant the disease is," she said. Once gland atrophy has set in, there isn't currently a way to restore or repopulate those glands, Dr. Gupta said. Those patients become significantly harder to treat because they have a higher disease severity. In terms of treatment options, Dr. Gupta suggested lid hygiene and warm compresses. "Those are things that can be done in a pediatric population," she said, adding "you're at the mer- cy of the child's ability to comply with therapy." For patients who have recurrent bouts of blepharitis and inflammation, Dr. Gupta sug- gested oral azithromycin. Eye drops containing antibiotic and/or steroids are often required for some length of time to help bring the disease process under control, Dr. Seitzman said. Treatment requires close follow-up to monitor the effect and for complications. For older children who can comply with in-office MGD therapies, Dr. Gupta suggested LipiFlow (Johnson & Johnson Vision), thermal pulsation, TearCare (Sight Sciences), and iLux (Alcon). She noted that these treatments are technically off label but said she has used them for patients in the 12–14 age range because they can be compliant and are accepting of the treatment. Dr. Gupta has done several studies in the pediatric population. One study looking at children ages 4–17 found 41% of the partici- pants had meibomian gland atrophy. 1 "This tells us that meibomian gland atrophy is present in the pediatric population, and patients with the greater atrophy are at greater risk for becoming symptomatic in the future," she said. She has also looked at how nutritional status and BMI may affect the pediatric popula- tion. 2 This study found that patients with higher BMI had more gland tortuosity. "Instead of ver- tical architecture, they were sideways," she said, which may be a precursor for atrophy. Dr. Seitzman and colleagues Julie Schallhorn, MD, and Julius Oatts, MD, have initiated an international consortium at the University of California San Francisco called the pediatric corneal disease consortium (PCDC). "Our first mission is to objectively study the incidence, present treatment patterns and historical visual outcomes of children with BKC," Dr. Seitzman said. "Our goal is to use the information to inform a prospective clinical trial to help this population."

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