I would access a paediatric anterior segment team at a big teaching hospital if you can, particularly for a child-friendly vision assessment (may be more appropriate techniques eg retinoscope/lens) and a better answer to the 'is it allergy or blepharitis or has he got vision/convergence issues?' question. If a doc says children don't get dry eyes you're in the wrong place.
If it's bleph they can fix it now. Maybe use warm water + cotton wool, or a warm wet flannel, as part of the bathtime hygiene routine, unless it worsens sensitivity, of course. You could check meibom now yourself if you're worried and can make it fun (!) - 2 fingers under the lower lash and very gentle pressure upwards. Look for tiny clear dots of oil along the lid margin. Make sure the ophth checks meibom anyway rather than just a cursory look in the slit lamp and tells you the difference between meibomitis and allergies, and condition of the tear film, any patchiness, and eye surface, checks under eyelids for allergy or inflammation signs. Report any lumps or bumps, chalazions, styes.
Allergy/hypersensitivity/diet precautions now sound like a good idea, as Hopeful2 and Shell, although I've done it surreptitiously by just not buying the junk. We're eating oily fish 3/week - salmon and mackerel - and reduced red meats and pork products and saturated fats to zero or minimum, cooking with light oils only, plenty raw fruit and veg, which young folks often prefer. (Bad fats and sugars are instant 3-4hr MG cloggers in LM's case. This is tough. It doesn't have to be eg zero sweets/candy or icecream or fries, small amount once a week alleviates the withdrawal symptoms. Obviously if you went very vegetarian you would rethink protein and vitamin nutrition. Just changing the overall habits in favour of producing good meibom oils and no metabolic inflammation/allergy eg no processed food or sugar drinks, use water + tiny bit of fruit juice concentrate. Eg children seem to like unskinned potatoes cut up, lightly tossed in small amount of oil and ovenbaked, good for many root veg. NB careful - we can't use the omega 3 oils this way because they change properties on heating. But some light oils, you can. Check the facts on different oils. Can also add some afterwards as a dressing.) Sounds as if you are already using minimum detergent for sensitive skin. Need to be super-careful about shampoos. Increasing humidity helps if it's tear film insufficiency. Also getting them used to wearing sunglasses in heat/wind. Although these environmental measures are not a fix, they can help restore eye surface health.
A paed ophth would be in case an adult service is unfamiliar with paediatric dry eye/allergy symptoms and assessment, or denies the existence of dry eye in paeds. This happens, don't get me started (!) The child eye surface behaves differently, prescription needs tailoring, maintaining it is a great skill. Certainly we have a very much more enjoyable experience in the paediatric service, especially for ongoing attention. I know you won't, but... I wouldn't be starting the consultation 'I've got dry eye myself and I just wondered...' I think he might get a fairer initial assessment, docs are only human and, personally, I avoid the overanxious mother tag, even though I am, and try to be as business-like as possible (unless you have something genetic, obviously it's good to mention allergy history). Especially since there Turned Out to be Something Wrong with my Daughter's Eyes Like I Said...
I'm guessing now, just from our personal experience. Vision changes fast while they are growing (a year is a long time in their time-scale), could need correction or amblyopia patching. Sometimes shows up at this age. Watch what he's doing when the discomfort happens, ask what he can see - eg TV, distance, handheld game console. Cover one eye to see if he's not happy. Rather than 'what can't you see?' compared to everyone else, which he wouldn't know, maybe try 'what can you see?' eg in the distance with each eye. Watch whether he's tracking OK or his eyes tire after a few pages when looking at books at normal reading distance. An optom would be checking the distance tracking, pupil reflex, visual fields, retinas etc for us too. Any observation you make is useful to them. The wet finger could be because of allergy itchiness. About this age, I started to notice tiny neuro-musculo-skeletal tics and details and wonder what they were. Nothing much, of course. Normally if it's tear film insufficiency from meibomian gland dysfunction, my daughter would be blinking and tearing more but closing her eyes against bright light, as Hopeful2, rather than opening and blinking.
Yes, we should be careful with our children's eyes and things do better when fixed early and he does deserve a proper assessment. Good luck finding good docs for a decent diagnosis.
Last edited by littlemermaid; 11-Jan-2012 at 09:37.
Paediatric ocular rosacea ~ primum non nocere