Dry Eyes in Children

Dry eyes in children are rare but potentially serious and may indicate a more problematic condition. It's important to pay close attention if a child is having recurring dry eyes and to seek treatment to rule out more serious conditions. Over time, if dry eyes are left untreated, vision and eye problems may be more likely to occur.

In this article, learn more about the symptoms, causes, and treatment for dry eyes in children, and how dry eyes may be a sign of a more serious condition.

Symptoms of Dry Eyes in Children 

Just like for adults, dry eyes are uncomfortable and may be especially painful for children. Symptoms may include the following:

• Children may frequently rub their eyes due to dryness and discomfort.
• Eyes may feel hot and dry.
• Eyes may be watery.
• Children may say they have sand or dirt in their eyes.
• Children may feel like their eyes are stinging or burning.
• Children may complain that their vision is blurry.

Causes of Dry Eyes in Kids

There is a wide range of reasons for why kids experience dry eyes. The condition may be due to common outdoor and indoor allergens, dysfunction in the eye glands, autoimmune disorders, endocrine issues, inflammatory disorders, and neurological conditions.

Common Causes

Common causes of dry eyes in children include:

• Meibomian gland dysfunction: Tiny glands on the eyelids produce oil that mixes with tears to form tear film. Tear film is important for healthy moisture in the eyes. When these glands aren't functioning properly, there either is not enough oil or the quality of the oil is not good enough. Evaporative dry eye occurs when this gland isn't working properly, and the eyes are not getting necessary moisture. One study indicated that nearly 42% of the children studied had some meibomian gland dysfunction.
• Common allergies: From pollen to pet dander to smoke, an allergic response to common indoor and outdoor allergens can cause children's eyes to become dry and irritated.
• Blepharitis: Blepharitis is an inflammation of the eyelid that causes dandruff-like flakes and can cause dry eyes.
• Medications: Certain medications, including oral contraceptives for teens, which may also be prescribed for acne or other noncontraceptive uses, can affect the moisture level in the eyes due to hormonal changes. Other medications that impact dry eye include antihistamines and acne medications.

Serious Conditions That Cause Dry Eyes in Kids

Sometimes dry eyes are an indication that a more serious condition is occurring. This is why it's important to seek medical care for persistent dry eyes in children.

Here's a list of serious and often rare conditions that cause dry eyes in children:

• Sjogren's syndrome: This is an autoimmune disorder in which the body's white blood cells, which are part of the immune system, fight the glands that produce moisture in the body. This can affect the glands that produce tears and oil for tear film and lead to dry eye disease.
• Juvenile rheumatoid arthritis (JRA): Dry eye disease is a common problem in children with JRA. In one study, 75% of those with JRA had dry eye disease and 5% had it severely. JRA can also cause uveitis (inflammation of the eye).
• Vitamin and nutrient deficiencies: Deficiencies in vitamin A and omega-3 fatty acids can cause dry eyes in children. Throughout the world, particularly in developing countries, vitamin A deficiencies are common in children under age 5 and cause blindness in 250,000–500,000 children each year. Deficiencies can be caused by poor nutrition or malabsorption of vitamins. Celiac disease, a genetic autoimmune disorder, can cause the malabsorption of vitamin A.
• Diabetes: Several studies indicate there is a significant increase of dry eye diseases among children with type 1 and type 2 diabetes.
• Endocrine disorders: Thyroid disorders, hormonal issues, and other endocrine disorders can cause dry eyes. These conditions are extremely rare in children but a common cause of dry eye disease in adults.
• Infections: Infections, including the herpes simplex virus, can affect the eyes. Conjunctivitis is another infection known to disrupt the tear film and cause dry eye disease.
• Genetic and neurological disorders: Genetic diseases and neurological disorders such as Riley-Day syndrome are quite rare but do cause severe dry eye.
• Stevens-Johnson syndrome: This is a severe immune reaction to medications that cause blistering of the eyes' mucous membranes. Advil or Motrin (ibuprofen) and sulfa drugs, including Bactrim, can trigger this syndrome.
• Vernal keratoconjunctivitis: A recurrent inflammatory disease of both eyes that affects younger males.

Treating Dry Eye in Kids 

Increasing moisture through the use of moisturizing eye drops is typically the first step in treating dry eye disease. A healthcare provider may have to try a few different treatments or types of medications, depending on what's causing the dry eyes.

Typical treatments include:

• Topical corticosteroids
• Topical cyclosporine
• Oral or topical tetracycline/doxycycline or other antibiotics

At-Home Treatments for Dry Eyes

While treatment is usually needed and necessary for dry eyes, there are a few things that you or your child can do at home to help reduce dry eye disease, including:

• During screen time, have your child take frequent breaks to focus on something other than a screen.
• Increase outdoor time.
• Use indoor humidifiers to increase moisture.
• Turn off fans at bedtime.
• Try warm compresses over the eyes to increase the oil produced by glands in the eye.
• Turn down the thermostat, and, if possible, reduce or avoid using heat indoors.
• Reduce or discontinue hair dryer use.
• Increase water intake.
• Have your child take vitamins and supplements if approved by your healthcare provider.
• Use eye protection when outdoors, especially in windy weather.
• Redirect car vents and fans so they aren't blowing on your child's eyes.

How to Give Your Child Eye Drops

Putting drops in a young child's eyes can be very challenging. Being prepared and distracting the child is key.

Some strategies for administering eye drops in children's eyes include:

1. Get ready: Before even attempting to insert eye drops, get all your supplies and the medicine ready ahead of time so everything you need is at your fingertips. If possible, ask for assistance from another adult. Shake the medication, and if the eye drops have to be refrigerated, bring them to room temperature by rubbing the medicine bottle between the palms of your hands, or place them in warm water.
2. Wash your hands: To avoid introducing bacteria into the child's already irritated eyes, make sure your hands are extra clean, and scrub fingernails too.
3. Distraction is key: Have the child pick a favorite show to watch or have them play a favorite app while putting the drops in their eyes. If they have a favorite toy or blanket, grab it as well.
4. Get the child in place: Place pillows and position the child down on their back once they are engaged with a distraction. Put the pillow under the child's shoulders or use a rolled-up towel under the neck to reduce their head movement.
5. Pick a name: Call the eye drops something other than eye drops, such as rainbow or superhero drops, to decrease the child's anxiety. Or take a cue from their favorite show and come up with a creative name.
6. Getting them still: If the child won't lie still, carefully and gently cross your lower legs over your child's legs to keep the child still. Keep in mind that just being physically restrained can be scary to a young child, so be calm yourself, be gentle with the child, and speak in a soothing tone if restraining them is necessary.
7. Show the way: If they are really scared, it may help to demonstrate first, either on yourself or with your child's favorite toy.
8. Place your hands: Place the wrist of the hand you'll use to give the drops on your child’s forehead.
9. Look up and to the other side: Tell your child to look up and to the other side. The eye drops should flow away from your child’s nose.
10. Place the drop: Bring the dropper close to within one inch of the child's eye.
11. Drop it in: Drop the medicine in the lower eyelid, but away from the tear ducts, which are located in the lower inner corner of the eye.
12. Comfort and cuddle: If the experience is upsetting to your child, once finished, affirm that they are all done and praise them for getting through a difficult task. Take some time afterward to hug, cuddle, or do a fun activity so that the experience ends on a positive note.

When to See a Healthcare Provider

If a child seems to have any of the following symptoms, it's important to see a healthcare provider as soon as possible:

• Eye infection
• Pus or thick discharge coming from the child's eye
• Redness or swelling around the eye
• Fever
• The child experiences vision changes

Summary

Dry eye disease is uncommon in children, but it can indicate that a more serious condition is occurring. Screen time is one of the main causes of dry eyes in children. Increasing outside time and reducing digital eye strain can help prevent screen-based dry eyes.

A Word From Verywell

Most of the time, infrequent dry eyes in children is not serious and can be remedied with moisture drops. However, it can mean something more serious is occurring. If your child has persistent dry eyes, seek medical attention from your healthcare provider or pediatrician. Effective treatments are available for underlying conditions that could be causing dry eyes.