Eyes of tomorrow: Exploring meibomian gland disease in children

Introduction Meibomian gland disease (MGD) is a broad term for meibomian gland dysfunction that results in altered meibomian gland secretions and tear film abnormalities.[1] Many studies suggest that MGD is becoming prevalent in the pediatric population,[2] and gland atrophy correlates with as little as 2 h of daily screen time.[3] Meibography is a newer in vivo and noninvasive modality for the screening of MGD, severity, and associated dry eye. Intense pulsed light (IPL) and low-level light therapy (LLLT) are emerging tools for MGD. Discussion Meibography was performed using an Espansione Me-check machine to diagnose MGD and evaporative dry eye [Figures 1-4]. Loss of glands, lack of meibum, or alterations in meibum composition are seen as dark lesions and quantified as a diagnostic parameter called meiboscore. It was graded as follows: Grade 0, normal meibomian glands; Grade 1, 25% gland atrophy; Grade 2, 26% to 50% gland atrophy; Grade 3:51% to 75% gland atrophy; and Grade 4:75% gland atrophy. This machine includes the OSDI-6 questionnaire to grade dry eye.Figure 1: MGD: Degree 1,2Figure 2: MGD: Degree 2Figure 3: MGD: Degree 3,4Figure 4: MGD: Degree 3Dry eye due to meibomian gland dysfunction was found to be 46% of the children and adolescent according to Pragnya Rao et al. in 2020.[4] In a study involving a predominantly Chinese population, Wu et al. reported that 28% of subjects (age 3–18 years) had some form of meibomian gland atrophy.[5] Allergic conjunctivitis also leads to meibomian gland atrophy and drop out in pediatric age group with less than 16 years of age as mentioned by Wu Y, Jiang H et al.[5] According to Liu et al., meibomian gland expression, distortion rates, and dropout grades were significantly worse in the seasonal group than the control group in children.[6] Grading of MGD helps treat with medical management or with Intense Pulsed Light (IPL) therapy or LLLT. This emerging tool has helped patients to diagnose and treat the MGD and associated dry eye. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.