The Feature Of Epidemiology And Meibomian Glands And Tear Film Lipid Layer In Dry Eye Of Children

PURPOSE1.To provide current estimates of the prevalence of diagnosed dry eye and risk factors of dry eye in 10-12 years old children.2.To estimate the correlation between the prevalence of dry eye in children and age and season based on the hospital data.3.To evaluate dry eye disease in children by Keratograph 5 M and lipiview ocular surface interometry.4.To evaluate the feature of meibomian glands and tear film lipid layer thickness in dry eye of children with long-term visual display terminals exposure.5.To evaluate dry eye disease in children with allergic conjunctivitis by Keratograph 5 M and lipiview ocular surface interometry METHODS1.Cross-sectional study.A representative sample of 1039,10-12 years of age in tianjin beichen district primary school.After a questionnaire survey,participants underwent slitlamp,Tear break up time(TBUT)and schimer I test to identify dry eye.2.Retrospective study,Whole clinical records were found in Tianjin Medical University Eye Hospital data of 0-16 year old children from 2016 Jan to Dec.The constituent ratio of diseases were analyzed based on the first dignosis.The prevalence of the dry eye was analyzed in different age,sex and season.The correlation between prevalence of the dry eye and age,season and other disease were analyzed.3.Cross-sectional study.This study involved 196 eyes of 98 children.The subjects completed questionnaires designed to detect subjective symptoms and risk factors for dry eye.Dry eye tests,including tear film break-up time,corneal-conjunctival staining with fluorescein,the Schirmer test,Keratograph 5 M and lipiview ocular surface interometry.The correlation between OSDI and other objective indexes were analyzed.4.Cross-sectional case control observation was performed.Eighty-four 6-14 years old children(149 eyes)with long or short time VDTs exposure from January toAugust 2017 in Tianjin Medical University Eye Hospital were enrolled,including 29 children 56 eyes for long time VDTs group and 55 children 93 eyes for short time VDTs group.Questionnaires were designed to detect disease history and ocular surface disease index(OSDI).Slit lamp microscopy,Keratograph 5 M,lipiview ocular surface interometry examination,corneal-conjunctival fluorescence staining,tear film break-up time(BUT)and Schirmer test(SIt)were performed on all the subjects.The subjective OSDI and clinical signs were compared between long time VDTs group and short time VDTs group and correlation between OSDI and clinical signs were analyzed in each group.This study followed the declaration of Helsinki.Informed consent was obtained from each subject or the guardian prior to any medical examination.5.Cross-sectional study.This study involved 42 eyes of 21 children.The subjects completed questionnaires designed to detect subjective symptoms and OSDI.Dry eye tests,including tear film break-up time,corneal-conjunctival staining with fluorescein,the Schirmer test,Keratograph 5 M and lipiview ocular surface interometry.RESULTS1.The mean age was 11.09±0.773 years old.The prevalence of dry eye according to OSDI or signs was61.5%(60.71% % among boy and 62.36%% among girl)and 5.58%(5.70% among boy and 5.45% among girl).In binary logistic analysis,associated factors with dry eye were othokeratology use(odds ratio [OR] =12.373,95%confidence interval [CI],1.995-76.735,p = 0.005),out door time(odds ratio[OR]= 4.381,95%confidence interval [CI],1.882-10.196,p =0.024),parents smoking(odds ratio [OR] = 2.323,95%confidence interval [CI],1.076-5.015,p =0.036).No significant difference was found in prevalence rate between urban and rural,among age,gender,nationality,Video display terminals(VDT)use time,spectacle use and influenza.No correlation was found between parents VDT use time and children.2.The number of 0-16 year old children was 22268(boy 12329,girl9939),age:8.23±3.83 years.Based on the first diagnosis,Dry eye(4.6%)was just lower than refractive error(52.3%)and conjunctivitis(23.1%).The prevalence of dryeye(7.6%)was positive correlated with age(r = 0.671,p = 0.004),The prevalence of chalazion was negative correlated with age(rs =-776,p = 0.000),The prevalence of conjunctive was negative correlated with age(rs =-0.919,p = 0.000).There are no difference of prevalence of dry eye and horedeolum in four seasons(?2 = 6.254,5.664,p = 0.1,0.129).The prevalence of chalazion was higher in winter than other seasons(?2 = 18.328,p = 0.000).The prevalence of conjunctivitis was higher in summer than other seasons(?2 = 27.740,p = 0.000).3.The percentage of children with BUT<5s was 85.5% and with S I t<5mm/5min was 16.1% children.OSDI was not correlated with TBUT and SIt(rs =0.099,-0.119;P = 0.354,0.259).OSDI was not correlated with Meiboscore and TMH(rs = 0.146,0.107,P = 0.168,0.323).OSDI was correlated with NBUT and NBUTav(rs = 0.238,0.336,P= 0.028,0.002).OSDI was not correlated with LLT,BR and PBR(rs = 0.048,0.022,-0.158,P=0.687,0.856,0.199).NBUTav was correlated with LLT and PBR.There are difference was found among BUT,NBUT,NBUTav(?2=49.242,P = 0.000).BUT was not correlated with NBUT and NBUTav(rs = 0.112,0.059,p = 0.159,0.455).meibomian gland dropout degree was not correlated with LLT(rs =-0.083,P = 0.494).4.Compared with the short-time VDTs group,high OSDI value and long NIBUTav were observed in the long time VDTs group,the differences were statistically significant(OSDI: t = 2.662,P = 0.009;NIBUTav : Z = 2.315,P =0.021).The meibomian gland dropout score was significantly different between the 2group(?2 = 11.779,P = 0.008).In long time VDTs group,OSDI was negatively correlated with SIt(rs =-0.598,P = 0.050)and positively correlated with meibomian gland dropout score and NIBUTav(rs = 0.522,P = 0.022;rs = 0.597,P = 0.011).In short time VDTs group,OSDI was positively correlated with first time noninvasive BUT(NIBUTf),average BUT(NITBUTav)and partial blink rate(rs = 0.372,P =0.030;rs = 0.408,P = 0.008;rs = 0.426,P = 0.050).5.OSDI was 13.8 ± 5.6,Itching was 2.85±2.22,TBUT was 3.06±1.78 s,SIt was 18.38 ± 7.53 mm,FL was 0.66+1.32,NIBUT:8.31+6.79 s,NIBUT av:8.80+6.57 s,TMH was 0.18 ± 0.06 nm,LLT:52.29 ± 18.36 nm,BR:17.23 ±7.42/min,PBR:0.62±0.36.OSDI was not correlated with Itching,TBUT,SIt,FL,NIBUT,NIBUT av,TMH,LLT,BR and PBR((rs = 0.347,P = 0.123,rs =0.240,p = 0.634,rs =-0.120,p = 0.634,rs = 0.410,p = 0.091,rs =-0.094,p= 0.712,rs =-0.120,p = 0.647,rs = 0.075,p = 0.775,rs = 0.085,p = 0.781,rs =0.464,p = 0.110,rs = 0.280,p = 0.354).There are no difference between dry eye with AC and dry eye with AC and VDT.CONCLUSIONS1.Dry eye is prevalent among 10-12 years old children.Increased risk for dry eye was noted for othokeratology use,out door time and parents smoking.2.Dry eye was the Third common disease in children.The Prevalence of dry eye in children was 7.6% in hospital.The prevalence of dry eye,chalazion and conjunctivitis was correlated with age.There are no difference of prevalence of dry eye in every months.The prevalence of chalazion was higher in winter than other seasons.3.In dry eye of children,short-BUT was the common type.The severity of subjective OSDI was greater than dye eye sign.NIBUT was correlated with OSDI.NIBUT was correlated with LLT.LLT was more useful than Meiboscore.Keratograph 5 M and lipiview ocular surface interometry can evaluate dry eye in children objectively and succinctly.4.Compared with short time VDTs exposure,the value of subjective OSDI was high and meibomian gland dropout was serious in long term VDTs exposure dry eye children.The OSDI value is associated with NIBUTf and partial blink ratio in short time VDTs dry eye children.5.In children with dry eye and AC,TBUT was short,Meiboscore was great,LLT was thin and PBR was great.