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    Treating blepharitis in the pediatric population

    How treating the condition in children differs from that of adults



    Doctors should consider nutrition in their management of pediatric blepharitis.

    Omega-3 fatty acids have anti-inflammatory properties on the prostaglandin (PGE3) pathway and been shown to improve chronic blepharitis in adults.19

    Current dietary recommendations for children and adolescents are two servings of fish weekly. Although ingesting high levels of mercury via fish intake is a concern, children can eat shrimp, canned light tuna, salmon, pollock, and catfish that have lower mercury levels.20

    Multiple new technologies to treat adult ocular surface disease have developed; however, these currently have not been studied regarding their roles in managing pediatric blepharitis. New treatments for blepharitis will continue to emerge, and optometrists should stay tuned.

    Treating pediatric blepharitis can be a positive experience, not to mention practice-building endeavor. Pediatric patients have many future years on the horizon in which they will continue to need eye care. Optometrists who succeed in treating the condition as well as communicating and encouraging the family are likely to increase their patient base.

    Related: What’s all the craze about demodex?


    1. Wong MM, Anniger W. The pediatric red eye. Pediatr Clin North Am. 2014 Jun;61(3):591-606.

    2. Beal C, Giordano B. Clinical evaluation of red eyes in pediatric patients. J Pediatr Health Care. 2016 Sep-Oct;30(5):506-14

    3. Smith G. Differential diagnosis of red eye. Pediatr Nurs. 2010 Jul-Aug;36(4):213-5.

    4. Wong VWY, Lai TYY, Chi SCC, Lam DSC. Pediatric ocular surface infections: A 5-year review of demographics, clinical features, risk factors,microbiological result and treatment. Cornea. 2011 Sep;30(9):995-1002.

    5. Guillon M, Maissa C, Wong S. Eyelid margin modification associated with eyelid hygiene in anterior blepharitis and meibomian gland dysfunction. Eye Contact Lens. 2012 Sep;38(5):319-25.

    6. Guillon M, Maissa C, Wong S. Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD. Eye Contact Lens. 2012 Sep;38(5):306-12.

    7. Gupta N, Dhawan A, Beri S, D’souza P. Clinical spectrum of pediatric

    blepharokeratoconjunctivitis. J AAPOS. 2010 Dec;14(6):527-9.

    8. La Mattina K, Thomoson L. Pediatric conjunctivitis. Dis Mon. 2014 Jun;60(6):231-8.

    9. Seth D, Khan FI. Causes and management of red eye in pediatric ophthalmology. Curr Allergy Asthma Rep. 2011 Jun;11(3):212-9.

    10. Teo L, Mehta JS, Htoon HM, Tan DT. Severity of pediatric blepharokeratoconjunctivitis in Asian eyes. Am J Ophthalmol. 2012 Mar;153(3):564-570.e1.

    11. Liang L, Safran S, Gao Y, Sheha H, Raju VK, Tseng SC. Ocular demodicosis as a potential cause of pediatric blepharoconjunctivitis. Cornea. 2010 Dec;29(12):1386-91.

    12. Deschênes J. Blepharitis empiric therapy. Medscape. 2015 Oct 30. Available at: http://emedicine.medscape.com/article/2018615-overview. Accessed 4/29/17.

    13. Zandian M, Rahimian N, Soheilifar S. Comparison of therapeutic effects of topical azithromycin soluntion and systemic doxycycline on posterior blepharitis. Int J Ophthalmol. 2016;9(7):1016-1019.

    14. Igami TZ, Holzchuh R, Osaki TH, Santo RM, Kara-Jose N, Hida RY. Oral azithromycin for treatment of posterior blepharitis. Cornea. 2011 Oct;30(10):1145-9.

    15. Çetinkaya A, Akova YA. Pediatric ocular acne rosacea: Long-term treatment with systemic antibiotics. Am J Ophthalmol. 2006 Nov;142(5):816-21.

    16. Meisler DM, Raizman MB, Traboulsi EI. Oral erythromycin treatment for childhood blepharokeratitis. J AAPOS. 2000 Dec;4(6):379-80.

    17. Skernivitz S. Exploring ocular demodicosis in chronic blepharitis. Opthalmology Times. March 25, 2026. Available at: http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/exploring-ocular-demodicosis-influence-chronic-blepharitis?page=0,2. Accessed 5/31/17.

    18. Tighe S, Gao Y, Tseng SCG. Terpinen-4-ol is the most active ingredient of tea tree oil to kill Demodex mites. Transl Vis Sci Technol. 2013 Nov; 2(7): 2.

    19. Macsai MS. The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:336-56.

    20. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gillman MW, Lichtenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L; American Heart Association; American Academy of Pediatrics. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation. 2005 Sep 27;112(13):2061-75.

    Read more here about blepharitis in our Blepharitis Resource Center

    Julie Tyler, OD, FAAO
    Dr. Tyler is a module chief of primary care at The Eye Care Institute at Davie and has been a clinical preceptor in numerous NSU clinics ...
    Rachel A. Coulter, OD, MSEd, FAAO, FCOVD
    Dr. Coulter is a professor of optometry at Nova Southeastern University where she teaches, sees patients, and performs clinical ...


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