Could my toddler have dry eyes?

[tiff]

My four year old son had an eye exam last year and everything was normal with the exception of a slight astigmatism in one eye. His eyes have visible red veins, which I always attributed to allergies (he has bad allergies and so does the rest of the family). Within the past year I've noticed him blinking strangely, kind of opening his eyes wide and then blinking a few times quite often each day. I've also caught him lick his finger and put it in the corner of his eye. When I ask him why he does this he says his eyes bother him, but never elaborates beyond that. He seems to have picked up on my eye problems even though I've done my best to shield him, so I don't know if that plays into all of this or not. Anyway, I plan to take him to my eye doc for an exam and wonder if any of you can comment whether he might have dry eye or if something else might be going on. thanks!

[Hopeful2]

Hi tiff,

He could certainly have dry eyes. Allergies run in my husbands family and my fourteen year old sometimes says her eyes are sore. Now that I think about it, I recall her being a toddler and complaining that the sun was too bright and that it hurt her eyes. I never made much of it, but now that I have dry eyes, I am thinking that she probably has some element of dry eye, maybe allergy induced.

On the other hand, it is possible that your son is reacting to your behaviour. Our children are very quick to notice when we are not well and when they are young, I think that 'role playing' could be their way of coming to terms with an parent's or sibling's illness. A colleague at work, has a young boy at home who has started complaining about leg pain and limping. The father had an accident about 8 months ago and is experiencing neuralgic pain at the sight of the injury.

Taking your little guy to the eye doctor for dry eye assessment sounds like a good idea!

[Shell]

perhaps he has allergies (dust? pillows esp if they contain feathers etc so try allergenic ones), make sure his diet contains plenty of nuts (esp walnuts for the omega 3), fresh salmon, green veggies, bananas and that he is well hydrated. You could try something like Nordic Naturals as a supplement (they do fish oils esp for kids - try vitacost or iherb.com - iherb is better)... If you live in a 'dry' hotspot you could try running a humidifier in the house/ in his bedroom at night...

Supps: these look good (fish oil and borage oil for GLA) but are age five years up (see reviews though - it might be worth bearing in mind for when he turns five if this persists)
http://www.iherb.com/Nordic-Naturals...Gels/4199?at=0
In my opinion these ones (below) don't look so good (contain sugar as they're gummies) but I think they're all age:
http://www.iherb.com/Nordic-Naturals...ies/16472?at=0


Sorry I couldn't help more... Bless the little guy, it's bad enough for adults! I hope and pray he feels better soon! Keep us posted...

Shell (Ps if he's taking anti-histamines for his allergies, this can cause eye dryness as cab allergies themselves - annoying! - so it's worth trying all of the above I mentioned and cutting out high fructose stuff and packaged foods..eat as close to nature as possible!) Others here are great and should be able to give you valuable info too!

[tiff]

thanks so much to both of you. i will check out those links and order him something as soon as he turns 5. in the meantime it will be a few weeks before my eye doc can get him in, but i'll post an update on what the results are of his visit. he has been using veramyst nasal spray for allergies, has an air cleaner in his room, mattress and pillow protection, i dust like crazy, etc., so there is nothing else i can do on my own. but, i will look into altering his diet to include more omegas. what else helps with dry eyes in terms of nutrition? i have pretty bad dry eye and my doc never mentioned anything besides omega and flax. thanks so much!

[Shell]

Sounds like you're doing a lot right for your little boy

Here is a really good link I found helpful re diet (scroll down but the page has lots of useful info)
http://www.visionworksusa.com/dryeyes.htm

Do keep us updated I hope you and your little one find relief soon...

Diet-wise: do try to avoid anything unnecessary ie additives, artificial flavourings, colouring, anything with high fructose syrup. Try to cook as much as possible from scratch and focus on white meats, fish, veggies especially the green cruciferous ones, nuts, seeds, some fruit, avocados I've read bananas are good so maybe a small banana each day in his lunch box? If he has them, avoid sugary, fizzy drinks..

Just thought I'd mention: the link I posted earlier for the dry eye supplement says 5+ but I noticed some of the reviewers had given the capsules to younger children. Might be worth asking the specialist if he can start on the capsules early in his case...

Shell

[littlemermaid]

Hi Tiff,

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.

[tiff]

This board is so incredibly helpful and comforting! Thank you all for your thoughtful responses.
I am taking my son to my eye doc tomorrow (he got us in in one day). I have no idea whether he has experience with children, but he's very good with my severe dry eyes and has been the only eye doc in our area that has had any idea what to do to help me. He also has the Tearlab device, which was hugely helpful for me. I'm unsure as to how to approach this. Littlemermad, I agree, I shouldn't say "I have eye issues and think he does too," but I'd like to make sure he examines him as fully as possible. Any suggestions on how I can do this in addition to just mentioning his symptoms? I'll report back tomorrow evening. thanks!

[Shell]

Just wanted to say that's great you got an appt. Hope you get some answers for your little boy and his eyes can be made much more comfortable. Don't know if you believe but I'll say a little prayer for your boy and will be thinking of you. Let us all know how he gets on!
Shell

[littlemermaid]

Hi Tiff, How about something like:
'We have a history of eye trouble in the family and, sadly, I'm wondering if he might be starting to suffer with his eyes too.
Fair and thorough assessment - I'm hoping he can be checked thoroughly at this age to see if we can catch any problems early on. [Paediatric ophth like this because this is one of their gripes that they can fix stuff early if the children get referred appropriately to them for early checks.]
Detailed observations - He's started rubbing his eyes and blinking differently and is obviously uncomfortable. We already know he has allergies [list them] and slight astigmatism but it would be a relief to know whether something else is going on. Especially whether he can still see well because his blinking has changed.
History - We all have allergies and I have very dry eyes now, so obviously it would be a huge relief to know there's nothing to worry about. I think he might need regular checks and advice on managing any signs of problems early since he seems to be uncomfortable. I would hate him to be overlooked or undiagnosed if there is anything he needs help with.'
Sometimes I go with 'I know it sounds/I don't want to be overanxious but..' to which the automatic reply is always 'no, no, of course you're not, you're right to ask/get it checked'. To get a thorough orthoptist check and to be taken seriously, there may have been occasions when I have, ahem, overemphasised certain (genuine) vision symptoms.

Sounds like you have a good relationship with your ophthalmologist and he does recognise dry eye symptoms despite the similarities. It is true these things start with small persistent signs (LM had tear spattering and photophobia to start with and it took a year to get an MGD observation diagnosis despite many many ophth examining her but hopefully those days are over for all of us). (I'm also thinking if he is atopic with allergy and the doc wants to 'try' drops, he needs to think twice and monitor it very carefully in case sensitivities develop on the eye surface and cause unwelcome changes. I so do not know what I'm talking about here but this is the direction research seems to be going.)

It would be great to hear what your ophth thinks and whether you agree. You are being such a fantastic mum noticing these signs and getting it checked out and he's a very lucky boy. Wish you all a great consultation, including your doc. Take a book for distraction while you're waiting! If the ophth isn't paediatric, maybe take a small distraction toy in your bag just in case he hasn't got the works, little wobbly finger puppet's a good one or some small character with a happy face.

[tiff]

So my son saw the doc today and one of his eyes has several blocked meibomian glands and the secretions from his glands are not ideal consistency, but rather thick and pasty. He also has some dryness in his eyes. The doc suggested we do blink tears once a day and a warm compress for five minutes each day and see him back in a few weeks to have a further vision exam (he seems farsighted) and see if anything improves with his MG.

I know many have children whose eye issues are far worse and so I don't mean to make a big deal out of this, but I'm worried and upset because he's only four. My eye problems are not good and I fear he's headed down my path of severe dry eye, MGD and other problems. How can artificial tears and warm compresses change the makeup of his gland secretions? I plan to modify his diet and hopefully that will help, but at the age of 4, it seems like nothing else can be done. I also worry that he's young to already have these problems.

I'd really love any thoughts or suggestions. I'm upset and super worried he'll not tolerate the drops. I use the same ones and so I told him we'll have our own special routine each night for only us, not his sister or his dad, but I can't imagine how he'll handle this and the compresses.

Thanks!

[Hopeful2]

Hi tiff,

Good for you for taking your son to the eye doctor! Did the doctor maybe suggest allergies? Do you think that maybe there might be some environmental issues that might be contributing or causing dry eye in your family?

I suspect there are environmental issues in my family. I am seriously thinking of dumping my front load washing machine because we are unable to get rid of the mold around the rubber seal and the drum. Our clothing and linen ends up holding the mold and then I think our eyes get exposed to it. Maybe there is something in your home that you are both reacting to?

[tiff]

Hi. He is on allergy medication already. The doctor didn't speculate on why ge had these issues, but I will ask at our next appointment. I tried to make putting the drops in tonight and he refused. I'm not sure what to get him to take the drops. Does anyone have suggestions? Also, how do we improve the consistency of his mg secretions?

I had no idea allergies cause dry eye. I've examined my house inside and out to eradicate allergens. If there is something here he is lucky because we are building a home in a new area. Hopefully that will help. In the meantime, I'm terribly worried about this.

Thanks everyone!

[Shell]

Sounds like you made some headway today

Here's hoping that the tears and compresses will help! Maybe you could try telling him the drops have special powers to make his eyes feel better but he has to be brave? Maybe the promise of a little reward if he allows you to do it? Maybe together you could design a little chart to plot his progress (say you want to use the drops 3 times a day, make 21 little stars with smiley faces and have a little tear by each of its eyes - stick one on his chart each time he does it and if he does it three times each day at the end of the day you could allow him a little treat, if he does it three times a day for a whole week he could earn a bigger treat... Kids love stuff like that and it should be a big incentive for him, along with lots of praise! If you can get it done once or twice it should be a lot easier for him to allow you to do it (when he sees it doesn't hurt)... As for improving MG secretions, I would honestly recommend the fish oils. You said he's on antihistamines - you do know that these dry the eyes out, or can? It might be worth trying a different antihistamine though I think they're all drying to some extent. Think about running a humidifier too

I don't want to frighten you or anything but have you considered having blood work done just to make sure it's not autoimmune... I may be way off track and I wouldn't want to panic you but is it worth a shot? It's just that an autoimmune condition causes my dry eye condition in main (plus I have ocular rosacea!)

Maybe best to see if the drops/ compresses help before doing anything else though - it might do the trick all alone! Did you ask about introducing the Nordic Natural children's fish oils?

Shell

[tiff]

I just have to repeat how comforting you all have been to me. I am so grateful for this board for both me and for my son.
Shell, great idea about asking the doc about Nordic Naturals. I'm going to ask at our visit in three weeks.
I'll try the incentive with my son and see if that helps. The drops are not painful at all, rather soothing I find, so hopefully he'll not have issues. I should add, he's the kind of kid who doesn't like water dripping in his eyes from the bath, so he's kind of sensitive.
The allergy med he's on is a nasal spray--veramyst. I am seeing our allergist in two weeks and will bring this up to him and have my son evaluated for another medication if his spray could pose any potential problem. His allergies have gotten worse, so I'm not sure we can forego treatment at all.
I had a host of bloodwork to try to find the source of my dry eyes and nothing came up. I speculated it could have been caused by a decade of birth control, but there's no way to be sure. I'm fair and have light eyes and my doc said people of Scottish and Irish descent (I'm part Scottish) have this more often. I've never heard that anywhere else though, so who knows.
I'm a little calmer now, thanks everyone!

[littlemermaid]

What a good eye doc. Eye treatment can be a pleasant, relaxing time with good attention at bedtime - LM's allowed on the big bed, lies in comfort, warm compress is timed, maybe with a fun timer at this age, chat/story/music. If you're using a flannel, prepare 2 or they don't last long enough. I have to say it feels like spa treatment... On the drops, they will go in on a closed eye if he's lying down, until he's happy taking them. They get used to people examining their eyes and quickly bunging various drops in the lower sac. I'm slightly wondering whether he actually needs much artificial tear and whether it's just the doc's standard treatment? How many a day? Maybe he will take him off it when he sees improvement.

The warmth melts congested oils in the eyelid glands, quickly relieves any blockages and as routine attention, prevents chalazion and styes. The consistency of meibom can be changed with diet and oils. I feel quite strongly at this point that it's important to avoid development of any further sensitivities around the eyes and surface changes from eye meds if possible so it's good to be vigilant. These clean eye measures will avoid infection and makes sure he doesn't need further intervention that might set up the sensitivities you are worried about. We ditched all bathtime products except basic soap and we were very careful when she was younger to use hypersensitive baby shampoo and not near the eyes. Humidifier is indeed a good idea. A little bleph is so very normal at this age and easy to fix. Children often get styes and chalazia, don't they. It is true that allergies can disappear in a different environment.

[Hopeful2]

Hi tiff,

You could try the old 'smartie' strategy. We used to use this when our girls were young and starting out with cross country skiing. You go a certain distance and you earn a 'smartie'. Worked like a charm. I know it is not ideal, but we can't expect a toddler to understand the benefits of drops, especially if he is not comfortable with water getting into his eyes. I suggest you get a smartie for your drop and he get one as well. It does not have to literaly be a smartie, but it can be some other form of treat. It does not even need to be a food item, maybe it is time on the computer for a game with mom/dad. The reward needs to be immediate and something meaningful to him.

Not all allergies show up on bloodwork. Have you considered going to a naturopathic doctor? Allopathic/conventional medicine typically tests for Ige allergens, naturopaths tend to test for Igg allergens. Ige is more of an immediate response, as in peanut allergies, Igg can be more of a delayed reaction.

Getting him onto a good EFA supplement is important. You might want to have his Vitamin D levels checked as well. Often with allergies, Vitmain D deficiency is present. I would also have him on a good probiotic. Most of our immunity is in out gut, and allergies are an immune related illness. You might also want to keep a food journal to see if you can figure out what might be triggering some of his allergies. My guess is that if you can reduce the allergic load on his system, then you will improve the overall status of his immune system and decrease his dry eye symptoms. Our bodies work holistically. As Rebecca has mentioned elsewhere, dry eye is not just about isolated eye balls.

It sounds like you are right on top of what is happening. Hats off to you!! You are way ahead of were I was with my kids at that age. . . I tended to minimize my daughter's complaints of sore eyes . . . Now that I have dry eyes, I am revisiting her issues. I am reintroducing the EFAs and Vitamin D. We have a jar of digestive enzymes on our dining room table, for everyone. We are all taking probiotics just before bed. All of this helps the immune system. Is this a magic bullet? . . . well no . . . but every bit helps. Remember to pay attention to the emotional/spiritual part of our lives. Take time to marvel at the beauty of life with your son. It will do both of you a world of good. Take time to laugh and have fun! This boosts our immune systems as well.

Please keep us posted. Looks like there are many of us thinking of you and wishing you well!!

Hopeful2

[tiff]

a few things have transpired since my last post:

my son is now amenable to using the drops and has, in fact, asked for them a few times because he said it makes the feeling that there is something sandy in them go away. i'm so proud of him! he won't let me do the warm compress for more than a minute no matter how or when i try it. i obviously will keep trying.

i saw our eye doc for my own issues and asked many questions about my son. the doc said he doesn't need omega supplements. i take them, as per his suggestion, and i know he's very into healthy eating and nutritional supplements, but he doesn't think my son needs them now. he thinks the blocked glands and thick, pasty secretions are not a result of allergies, but possibly genetics (i also have this issue) or it's just something he could grow out of when his hormones change during his teenage years. he said my son might have dry patches on his eyes, but that his "tear lake" is deep and he has many tears so he suggested we do the drops 1 to 4 times per day to help with the foreign body sensation rather than because he thinks he doesn't make enough tears. so, i'm calmer now, but obviously still concerned so i plan to take the advice given thoughtfully by all of you and keep an eye on this. he sees the doc in three weeks and i'll post here afterward to keep everyone updated. thanks so very much!

[tiff]

Hi,
My son had his follow-up appointment and had another vision test. He is farsighted, but not enough to warrant glasses. The glands were still blocked and the doc suggested a few weeks was not going to unclog them, but said that when his hormones change in his teenage years there is a good chance his glands will unclog and his secretions will be less thick and more ideal. He suggested we continue with the blink drops and do the warm compresses and he doesn't need to see him back for 1.5 years. I asked why he has these gland issues and he said it's possibly genetic (I have them). Should I be satisfied with this? Is there anything more I can do? thanks!

[littlemermaid]

Tiff, The link below gives you current protocol for MGD in US paediatric eye clinics, with very great thanks to Mark Jacobson.

Eye surface definitely needs monitoring more frequently than 1.5y if he does have unresolved MGD + allergic blepharitis at 4yo. Could it be the ophth is not familiar with these conditions in children?

Childrens' hospital eye clinics use omega 3 oils first-line treatment for MGD with warm compress and expression. (The preference for flaxseed oil may be to avoid mercury in fish oil.)

4/day artificial tears is a lot in chronic daily use at 4yo with no improvement on MGD. Obviously whatever we use affects the eye surface and tear functions. Our paed hospital eye clinic goes for minimum effective intervention and aims to taper as MGD resolves and functions restore, although frequent tear sub drops can be necessary to maintain the eye surface meanwhile.

The 'unclogging of the glands in puberty' theory is a new one on me - it seems the opposite for many people.

Epiphora (aqueous over-tearing) is an early sign of compensating for lack of oil in tear film due to MGD. It progresses to lack of tears as the eye surface changes. So tearing would not look dry at this stage in MGD. Dry patches on the surface are consistent with this, which may progress to keratitis. You were saying the tear substitute drops are to relieve gritty feeling rather than itching.

The paediatric eye surface behaves differently to adult, which general ophth and docs don't realise. Also children are much less likely to complain about, or realise they have, symptoms.

Search on 'child blepharokeratoconjunctivitis' to get fully informed and help you with decisions.

Consider examination by a paediatric anterior segment/surface disease/dry eye specialist with a large state teaching hospital. There are such excellent people. Search hospitals on 'child blepharitis'.

A paediatric eye clinic or paediatrician would also advise on coordinating eye allergies and the Veramyst (nasal steroid affecting the immune system, any sign of spots around eyes, mouth, nose, search on 'child eye periorificial dermatitis').

These are your guys if you need them - American Association for Paediatric Ophthalmology and Strabismus: conditions (blepharitis, allergy), find a doc http://www.aapos.org/

HERE IS CURRENT TREATMENT PROTOCOL
'Current Management Strategies for Blepharokeratoconjunctivitis' by Mark E Jacobson, American Academy of Ophthalmology 2011, Paediatric Ophthalmology Subspecialty Day programme (go to pages 50-52) http://www.aao.org/pdf/Pediatric-Oph...1-Syllabus.pdf

'Mean age of symptoms at age 4 and mean age of referral for treatment at age 6'
'Blepharitis accounts for 12/15% of referrals'
'Mainstay in my mind is omega 3/flaxseed oil' '1 teaspoon per 33 pounds up to a maximum of 1 tablespoon if 100+ pounds'
Warm compress + flaxseed oil, maybe topical antibacterials, follow-up 6-8wk, if unresolved after a good try, oral antibiotics (rare)
PBJ sandwich How does that improve the lipids? We are reducing all other fats, esp, as he says, processed foods.

Hope you can clear the MGs without any more hassle!

[If any paediatric specialists can help us - the little fella's only 4 - here's the way http://www.dryeyezone.com/talk/showt...7763#post67763]

[tiff]

Little mermaid, I just now read your response after a tough night with my son. Before bed he complained that his teachers don't do anything to help his eyes. I had no idea he had been complaining about his eyes at school. I alerted the teachers of this via email tonight and asked them to help him administer his drops when he complains.

I'm so worried for him. He is back to licking his finger and sticking it in his eye's corner. He will only let me put his drops in when his eyes are closed so I'm not even sure much is getting in there. I am still struggling with the warm compress, he doesn't let me do it for long no matter what I try.

So you think he might have blepharitis? The doc didn't mention this. He also didn't think this was from allergies. How would we find out whether the mgd and gritty feeling is from allergies? I've stopped his allergy med (veramyst) because I worry it might make this worse. He needs allergy meds, or at least without them he has dark puffy circles under his eyes, so I'm not sure what to do. I'm going to check out that link you included to see if there is a better doc around here.

I know you personally dealt with eye issues with your daughter, right? How did you manage to remain calm about it? I'm besides myself with worry and sadness that he's dealing with this because I truly fear it will get to the point of my eye problems and it will hurt him to be in the sun, air conditioning, heating, have constant eye pain, blurred vision, etc.

Thanks for listening to me go on and on about this.

[Hopeful2]

Hi tiff,

I am so saddened to hear of your son's struggle with his eyes. There is no way that a child should be going through this. . . I guess we can't pick and choose what ailments befall us or our children.

I know you have already taken him to one eye doctor. Do you think it might be worth getting a second opinion? Is it worth getting back in touch with the first doctor for additional testing or a more in depth treatment plan?

This might be way out there. . . do you think that your son might be stressing about things? I notice my eyes are worse when I am stressed. Stress causes us to constrict our breathing. On the up side, I also notice that when I pay attention to my breathing, my eyes feel more moist.

I believe I read somewhere that allergy meds (antihistamines) can dry out eyes. Do you know what he is allergic to? Would eliminating common allergens help?

I wonder if your son might be more comfortable with a cool compress? What about getting some audio books so that he can listen to them while having the compress warm/cool on his eyes?

Hopeful2

[littlemermaid]

So my son saw the doc today and one of his eyes has several blocked meibomian glands and the secretions from his glands are not ideal consistency, but rather thick and pasty. He also has some dryness in his eyes. The doc suggested we do blink tears once a day and a warm compress for five minutes each

Hi Tiff, You were saying the ophth saw no improvement and does not recommend flaxseed oil, whereas Mark Jacobson is using omega 3 as a first-line treatment for MGD to improve the meibom.

Blepharitis just means something wrong around the eyelids (it is a convenient search term for you to read up). In diagnosis, you want to know specifically what is wrong around the eyes. The doc said he has seen MGD. Obviously, there's allergy involved but 'allergic eye' may not be the primary cause of the dryness.

You are looking for a paediatric ophthalmology specialist who knows what's happening and can treat it successfully. We did not find diagnosis, even, until we went to a national childrens' hospital eye clinic (we wasted 1y trusting that local ophth knew what it was and what to do, they didn't and did not own up). The problem is that although children with MGD could be fixed or managed nearer to home according to best current practice, the general ophth mostly don't seem to know what they're doing. (See how Mark Jacobson reports 2y delay in diagnosis and treatment by local ophth; same in UK, Mr John Dart's 2005 paper on 'blepharokeratoconjunctivitis' listed in the refs.) As Dr Jacobson says, it's common and fixable but you need to be careful to avoid progression of the condition (unless it turns out to be a systemic problem in which case you need help with ongoing maintenance to look after the eye surface).

I can't see another way round this apart from a paediatric eye specialist, maybe to be found at a large regional teaching hospital. Diagnosis and treatment is a massive relief. So is the feeling that the doc knows what they're doing and has seen it many times before.

Do you want to PM me to chat?

With warm compress, we find it works just to use a warm flannel to clean in a warm steamy bath or shower. As long as the eyelids are warm, the meibom melts.

<hug to you both>

[tiff]

I tried to sneak some flax oil in his pb and j today and he hated it so I'm going to have to get creative.

A year ago, before I had any idea he had mgd, I took him to the Cleveland Clinic where he saw the head of the department who is listed as a pediatric opthalmology specialist and he didn't even look at my son's eyes through the equipment that his new eye doc uses, didn't use drops to check for tear break up time, didn't push on his glands to see what kind of oil they secrete, etc. I asked if my son had blepharitis and he said no. I feel as though this doc is clearly not well-versed in the circumstances we need attention for otherwise he would have picked up on this problem. Interestingly, he's included in the online publication you sent me a link to in your second most recent response to my thread. So, I wonder how to know which doc has any idea what they're doing. It's frustrating and I hate to make my son paranoid by taking him from eye doc to eye doc until we find the right person. Should I go interviewing eye docs for him first?

Thanks!

P.S. Will a pediatric opthalmology specialist definitely know about dry eye, mgd, etc.?

[Hopeful2]

Yes, I would absolutely interview eye docs first. I would ask them what tests they would do, what treatments they would consider (and at what point), what their follow-up schedule looks like.

Also, there is no need for your son to know that you are frustrated with a particular doctor. You can let your son know that each visit is just a get to know you session with a doctor.

I would try getting the flax oil into his pudding or yogurt.

[littlemermaid]

Will a pediatric opthalmology specialist definitely know about dry eye, mgd, etc.?

No. They specialise like the adult service, it has to be a dry eye, cornea specialist.

I wonder how to know which doc has any idea what they're doing

Options:
- ask Rebecca
- email enquiry to eye clinic patient information service
- email experienced paed ophth dry eye specialist for advice on who to see nearer home (concise letter, summary of history)
- look at current research to see who's working on what

I would start by looking at Cleveland Clinic website again. I'm seeing 2 obvious possibles listed with dry eye and blepharitis interests, Heather C and Peter McG (ET looks too general, from your experience, hopeless). http://my.clevelandclinic.org/staff_...y_search.aspx#

make my son paranoid by taking him from eye doc to eye

Absolutely. You can enquire in advance who is the best person to see - the desk staff will know all too well (be watchful for subtle hints). Children's hospitals are fun places, very different to adult service. The little guy will take his cues entirely from you and may even consider it a fun day out and enjoy the attention. It is difficult not to show the stress. However, you and the little guy will be massively relieved that the staff know what they're doing to stop his eyes bothering him. And he will do the treatments if the doc he likes says so. We always treat it like a day trip and go on somewhere good afterwards, picnic in the park, aquarium, boat trip.

If that doesn't work out, you have eg Ohio State Childrens, Cincinnati Childrens and Pittsburgh Childrens. Keeping in mind I'm English and have no concept of what's involved even getting there! (If you're really in trouble and you need to email someone for advice, try Ken N at Pittsburgh Childrens.)

I dearly hope this is not completely wrong. It is so difficult, I've no idea what it's like in the US. Again, my best results have been from a combination of local support but treatment in the big regional centres, purely because there are no experienced paed ophth on this local to us. Hopefully, you can work with a paed ophth in Cleveland, if that is your local centre (but you have the university teaching hospital clinics if you need them). At this point, no one's actually assessed what the little fella has, so hopefully it's a quick-fix for mgd/blepharitis, and also getting sensible advice on managing the allergies.

Tiff, PM me any time.

[wagnermid]

Hi,
I have 9 year old who has a similar problem from a different cause.

We use flaxseed capsules rather than liquid as he hated it, he takes 3x1000 mg each day. They are quite big but he swallows them when "buried" in a big spoonful of yoghurt. It took a lot of practice !

For warm compresses we have quiet cuddle time on the lounge before bed. I have a jug of warm water next to me and wring out a washer and I hold it on his eyes, one at a time. Often it is only for a minute but I repeat it as often as he'll let me and we can usually manage 10 minutes in total. We read a book or watch a DVD. He has gradually gotten used to it , sometimes he counts or we put the oven timer on to help pass the time. He has a disability so his ability to sit still is not that of a typical nine year old.

Hope you get some answers soon.

[littlemermaid]

Hi Wagnermid, Yes, we ended up with just taking capsules and a big drink and then food to make sure it's down. I think the Barleans Swirls taste lovely but she still complains. These were in our local health food shop. Plus they've made an effort to help us with child-friendly products http://www.barleans.com/

I like flaxseed oil in salad dressing but it's still a nutty strong taste for her and she detects it altho' I've got away with a small amount poured on homemade nutty flapjacks and muffins, but they have to be strong nutty tasting eg walnut. Unfortunately we can't cook with these oils, but I use other light cooking oils like olive and walnut (they have to be specifically for heating), plus we eat oily fish 3/wk. Young ones seem to like eg salmon a lot. Mine always loved to see a whole fish, which can be surprising to adults.

I think we have to improve the lipids with minimum processed and animal fats.

UK has started stem cell therapy for limbus so I guess Sydney is the best place to be if there's any safe action, if they still think it's that.

I can't believe I missed your previous posts. For years LM and I've felt we were alone with this, dry eye child, although I know there's plenty more out there. Best wishes for comfort and healing and happiness to you both.

[Rebecca Petris]

Hi tiff. I am so sorry I had not followed this thread till now.

Re finding a doctor, I have pm'd you to ask for location. There ARE pediatric ophths who know dry eye just not that many. However, a pediatric ophth can be a really good asset regardless, if they're a good one. Think teamwork maybe. Cornea for their specialized knowledge, pediatric for their dedication to getting to the bottom of things & regular follow-up. (By the same token, many dry eye adult patients find an optometrist helps them more than the cornea doc though theoretically they have less training in this.) Problem with cornea MDs is the vast majority are more interested in corneal surgery than corneal disease, so you really have to pin down one that actually likes corneal disease. And of course the problem with EVERYBODY except the special few is, they're often too hung up on clinical signs to care about symptoms. However, sounds like your son has enough clinical signs to warrant more attentive care anyway.

I plan to modify his diet and hopefully that will help

I have a friend who is a pediatric ophth who sees a lot of dry eye in kids and I know one of the most frequent pieces of advice she has to give out is diet modification, esp eliminating sugar (sodas & such) and other bad stuff.

he's the kind of kid who doesn't like water dripping in his eyes from the bath

Wonder if that might have been an early sign of irritation from poor tear quality. Just a thought. Water irritates my eyes too.

He suggested we continue with the blink drops and do the warm compresses and he doesn't need to see him back for 1.5 years.

When clinical signs are minimal that might seem reasonable to the doc but for anyone, and especially a kid, with the extent of your son's symptoms that is really wrong. Kids can tolerate a lot before they start showing something's wrong and a pediatric doc with enough experience of this would know. - Also in completely healthy patients, MG function is entirely a result of age - starts out phenomenal in infancy and gradually declines over the decades so the most elderly are the ones with the fewest MGs functioning. I may well be oversimplifying but to me this says, if a bunch of them are not working right at his age, yes, they need to be dealt with and causes pinned down.

I really agree with the others about finding some way to make the interventions fun if at all possible. - My daughter is 9 now so not quite as into it but at 4, oh my gosh, she was so fascinated by all the dry eye gear I have in the shop and was always begging for stuff. Had a box of all her own goggles, sleep masks, rice baggies and such. I think I still have on my profile somewhere a picture of her with a Tranquileyes goggle on when we were flying to Boston for my sclerals one time. (No, she doesn't have dry eye.)

You can make mini rice baggies that double as bean bags to toss and warm compresses to sneak onto his eyes while you're reading to him. Have to get clever with ways to distract (as others have mentioned) in order to keep some heat on there for 5 minutes at a time (and I really would suggest using either rice or some other compress capable of retaining heat for 5 minutes - then you don't need to do it more than once).

I'm wondering too if there's any special buddy he has with a nice mom that would be willing to let you educate them a little about this so they could be supportive.

Random thoughts for what they're worth!! Above all though please, please do not let yourself mentally extrapolate this problem ahead for years let alone decades. Treat it as a deal-able current crisis, not as the beginning of a chronic crisis. Sounds like he's got a good aqueous situation and I feel confident that as things progress with better professionals, better info etc on everything from diet to medical care you'll see good progress and get more comfortable with the routines.