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Tear Film and Meibomian Gland Characteristics in Adolescents

Tichenor, Anna A. OD, PhD; Ziemanski, Jillian F. OD, MS; Ngo, William OD, PhD; Nichols, Jason J. OD, MPH, PhD; Nichols, Kelly K. OD, MPH, PhD

doi: 10.1097/ICO.0000000000002154
Clinical Science

Purpose: To establish normative values of ocular surface parameters in adolescents and explore factors associated with meibomian gland (MG) dropout.

Methods: Subjects between 8 and 17 years of age were enrolled in this cross-sectional study. All subjects were given dry eye and lifestyle questionnaires. Tear film assessments and meibography were performed. Statistical tests included a one-way analysis of variance to test differences in ocular surface parameters between age groups and linear correlations between clinical findings and lifestyle factors.

Results: Two hundred twenty-five subjects completed the study. Thirty-four subjects (15%) reported ocular discomfort, primarily itching. Tear meniscus height increased with age and was greatest in the oldest subjects (mean = 0.25 mm, P < 0.01). Across all subjects, meibography showed that 39% of the upper and 39% of the lower eyelids had MG dropout. The average MG dropout score was 0.50 ± 0.57 for the upper eyelids and was 0.67 ± 0.93 for the lower eyelids. There was no correlation between phone/tablet usage and MG dropout for either the upper (P = 0.39) or lower (P = 0.56) eyelids.

Conclusions: The frequency of ocular symptoms in these adolescents was 15%. Because MG dropout is thought to increase with age, it was unexpected to observe that most subjects in this study had mild MG dropout in 1 or both eyelids. Although electronic device usage did not correlate with MG dropout in this study sample, it is still unclear what the effects of long-term digital device usage may have as the subjects age.

University of Alabama at Birmingham, School of Optometry, Department of Optometry & Vision Science, Birmingham, AL.

Correspondence: Kelly K. Nichols, OD, MPH, PhD, University of Alabama at Birmingham, 1716 University Boulevard, HPB 121, Birmingham, AL 35294-0010 (e-mail:

This study was funded by OCULUS, Inc.

The University of Alabama at Birmingham has received research funds from Alcon, Allergan, Shire, and Johnson and Johnson Vision on behalf of J.J. Nichols. J.J. Nichols has honoraria from Alcon and Shire. The University of Alabama at Birmingham has received research support from Alcon, Allergan, Kala Pharmaceuticals, NIH, OCULUS, Shire PLC, Sight Sciences, TearScience, and TearSolutions on behalf of K.K. Nichols. K.K. Nichols has been a consultant for Alcon, Allergan, AxeroVision, Bruder Healthcare, InSite Vision/Sun, Kala Pharmaceuticals, Parion Sciences, Santen, ScienceBased Health, Shire PLC/SARcode, Sight Sciences, SilkTech, and TopiVert. The remaining authors have no conflicts of interest to disclose.

Received December 05, 2018

Received in revised form August 12, 2019

Accepted August 15, 2019

Online date: September 17, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.