The Dry Eye Zone

Rebecca's Blog


Abstract: Where is the data on children's tear film health?

21 years worth of research was analyzed in an attempt to summarize what we know about tear secretion and tear stability in children.

The result? We’ve got some data but… we need much more.

There’s no excuse for this. If we don’t have data on healthy children’s eyes, how are we supposed to be able to study, for example, the effects of device usage on their eyes? We have to have the benchmarks to start from.

We need far more pediatric dry eye research.

Ocul Surf. 2018 Sep 30. pii: S1542-0124(18)30060-0. doi: 10.1016/j.jtos.2018.09.006. [Epub ahead of print]

The ocular surface in children: A review of current knowledge and meta-analysis of tear film stability and tear secretion in children.

Chidi-Egboka NC, Briggs NE, Jalbert I, Golebiowski B.



A review of ocular surface and meta-analysis of tear stability (tear break up time, TBUT) and tear secretion (Schirmer test) values in healthy children was conducted.


Articles published between 1996 and 2017 indexed on MEDLINE, PubMed, Embase, Scopus and Google scholar were retrieved using defined search terms. Statistical analysis (including sensitivity analysis and meta regression) was performed.


23 studies were summarised (5291 neonates (0-29 days), infants (1 month-1 year) or children (1-18 years)) and a meta-analysis conducted using 15 eligible studies (1077 participants). The combined mean TBUT in children was 14.64 s (s) (95% CI, 11.64, 17.64) and 21.76 s (95% CI, 20.43, 23.09) for sodium fluorescein TBUT and non-invasive TBUT respectively (NIBUT). The combined mean NIBUT was 32.5 s (95% CI, 31.78-33.22) in neonates. The combined mean Schirmer I with and without anesthesia were 16.26 mm/5 min (95% CI, 13.17, 19.36) and 29.30 mm/5 min (95% CI, 27.65, 30.96) in children and 9.36 mm/5 min (95% CI, 6.54, 12.18) and 17.63 mm/5 min (95% CI, 12.03, 23.23) in neonates. Meta regression showed a significantly lower TBUT in children from studies conducted in Asia (p = 0.004).


There is paucity of data on ocular surface variables in healthy children, making it difficult to draw valid comparisons with adult values.