Children with Allergic Conjunctivitis Have Elevated Risk of Meibomian Gland Atrophy

A recent cross-sectional study highlights a significant link between allergic conjunctivitis and meibomian gland atrophy in children. Researchers found higher MGA rates in younger patients, with screen time identified as a contributing risk factor and outdoor activity as protective. The findings underscore the importance of early AC diagnosis and intervention, especially in children under 12, to help preserve long-term ocular surface health and gland function. These images from the study show how the Keratograph’s polygon selection tool was used to isolate relevant findings for measurement. Photo: He WF, et al. Int J Ophthalmol. 2025;18:5:832-839. Click image to enlarge. The incidence of allergic diseases has been increasing over the past three decades. One of the most common types, allergic conjunctivitis (AC), affects more than one billion people worldwide, particularly children and adolescents. AC diagnosis and treatment are frequently delayed due to atypical symptoms or inaccurate descriptions provided by the pediatric patients themselves, and over the long-term, AC can lead to morphological and functional disorders of the meibomian glands. Limited research exists on the extent of these changes in children, but a new study published in the International Journal of Ophthalmology looked at the rate of meibomian gland atrophy (MGA) in children with allergic conjunctivitis. Their findings not only suggest that allergic eye disease exacerbates gland atrophy, but screen time also negatively affects it, while outdoor exercise was seen as a protective factor against the disease.The cross-sectional study, conducted in China, included 60 children with AC aged six to 17 (45 boys and 15 girls), and 20 age-matched children without signs or symptoms of ocular surface dysfunction (11 boys and nine girls). Researchers collected data on the duration of allergic conjunctivitis, untreated time, electronic screen time, outdoor exercise time, body mass index and frequency of eye rubbing. Dry eye assessment was obtained with the Standard Patient Evaluation of Eye Dryness (SPEED) score, and meibomian gland images were obtained using Oculus Keratograph 5M, and the rate of MGA was calculated using the device’s Image J software.Results of the study were as follows:The gland atrophy rate in the allergic conjunctivitis group was 33.4%, significantly higher than that in the control group (18.1%). The MGA rate was also significantly higher in children 12 or below. The AC group exhibited significantly higher average Meiboscore, distortion score, SPEED scores, lower fluorescein tear break-up time and lipid layer thickness.After performing linear regression analysis, screen time was a risk factor for rate of atrophy, while outdoor exercise time was a protective factor against it.Untreated duration of allergic conjunctivitis was identified as a risk factor for rate of MGA.Eye-rubbing frequency was associated with meibomian gland distortion score.There was no correlation between sex and BMI with the rate of MGA.Regarding the higher rate of meibomian gland atrophy in children under age 12 vs. those 12 and above, the study authors wrote in their International Journal of Ophthalmology paper, “This suggests that the severity of MGA is higher in younger children with AC, possibly due to a lower tolerance of meibomian gland acinar tissue to inflammation at a younger age, leading to more significant damage to the meibomian glands.”Researchers say this study does confirm previous research that outdoor activities have positive effects on the physical and mental health of children, including reducing myopia. However, children with AC tend to limit their outdoor activities due to allergies to dust and pollen, according to the authors. “Our study reveals that children with AC who spend more time outdoors have lower” rates of gland atrophy, they wrote in their paper. “Previous research has also indicated that outdoor activities can help improve allergic asthma. Therefore, we recommend that children with AC should still engage in outdoor activities, but they should choose outdoor exercise venues based on the types of allergens present.”The specific allergens affecting each child were not detected in this study, which is a potential limitation. Another shortcoming noted by the authors is that they did not take into account the impact of refractive status on meibomian gland morphology. Previous research suggests that the noninvasive tear break-up time is shorter in myopic children and that myopic children are more susceptible to dry eye. “Different refractive states may also have a certain impact on the morphology of the meibomian glands,” wrote the authors. “Therefore, it is necessary to include refractive state as a factor affecting the morphology of the meibomian glands of children in future studies.”In conclusion, this study encourages timely detection and effective treatment to mitigate meibomian gland atrophy. Children affected by allergic conjunctivitis should limit prolonged use of screens at close range and increase outdoor activities appropriately to help reduce their risk of MGA.Click here for the journal source. He WF, Wu YP, Zheng JW, Huang BG, Zuo JJ, Li JY, Jiang D, Ma HX. Meibomian gland atrophy in children with allergic conjunctivitis. Int J Ophthalmol. 2025;18:5:832-839.