At SECO 2026, Janelle Davison, OD, presented on factors that contribute to dry eye disease (DED), especially meibomian gland dysfunction (MGD), in younger populations. This phenomenon now affects between 5.5% and 23% of the pediatric population in the United States, she said. According to her presentation, nearly a third (31%) of these children (aged 5 to 18 years) also have severe meibomian gland atrophy (a score of at least 2) and 84% have severe tortuosity.^1,2 She further cited prognostic data that suggest objective signs of MGD often appear between ages 24 and 29 and precede the onset of classic dry eye symptoms.³

Digital device use, lifestyle factors, and modern beauty practices are accelerating the onset of dry eye signs and MGD in these younger populations, Dr. Davison said, and she provided screening, therapy, and management options for this age group.

Contributing Factors to Dry Eye in Young Patients

Dr. Davison noted that digital device use exceeding 2 to 3 hours per day is a significant contributor to ocular surface changes in young patients. Reported effects include reduced tear break-up time, decreased tear film stability, lower blink rates, increased interblink intervals, and a higher risk of digital eye strain and myopia. A blink frequency threshold of approximately 20 blinks per minute is critical for maintaining tear film stability in young adults with dry eye symptoms, she said.

Higher body mass index, poor diet, limited outdoor activity, urban living, ocular allergies, and underlying systemic conditions are also contributing risk factors for early dry eye development, Dr. Davison continued. TFOS DEWS III recommends optimized blinking, environmental humidification, adequate hydration, and dietary supplementation with omega-3 fatty acids as cornerstones of management for teenagers and young adults.

Adolescent girls commonly use multiple personal care products daily and college-aged women use a median of 8 products within 24-hour periods, Dr. Davison said. These practices, she noted, increase exposure to parabens and other chemical ingredients which are not only associated with dry eye severity and meibomian gland toxicity, but also gland cell atrophy and death within 24 hours of exposure at approved concentrations. Dr. Davison examined marketing buzzwords on products that can lead young users astray:

• “Vegan” or “no animal-derived products” does not guarantee safety or efficacy.

• “Eye doctor tested/approved:” Cosmetic users should be wary of vague claims without standardized testing protocols.

• “Organic:” Like “vegan,” natural ingredients don’t always mean that a product is safe for use around the sensitive adnexa.

In addition to the lack of a mandatory recall system in the United States, only 11 harmful ingredients have been banned. Further, Dr. Davison added, not all ingredients need to be listed on products by law. She then listed “The Dirty Dozen”— ingredients including parabens, fragrance, formaldehyde, and more—that are linked to cancer, hormone disruption, allergies, and other health issues and can be found in cosmetic products.

She cited clinical study data that indicate up to 85% of young cosmetic users report at least 1 ocular adverse reaction to their products.⁴ Users who apply eyeliner to their waterline or get lash extensions, chemical lash lifts, or lash perms are at increased risk of MGD and ocular surface irritation.

Clinical Screening and Management in Younger Patients

Dr. Davison outlined a structured clinical protocol for early screening, standardized questionnaires, baseline meibography, and age-appropriate diagnostic testing. She identified noninvasive tear break-up time, tear osmolarity, MMP-9 testing, and interferometry as useful tools in younger patients, alongside careful lid and lash evaluation to detect blepharitis and Demodex infestation.

Treatment strategies begin with foundational therapies such as preservative-free artificial tears, warm compresses, and lid hygiene across all age groups, she suggested. For patients 21 and older, additional options include immunomodulatory medications, neuromodulation therapies, and lipid-based tear supplements. In-office procedures such as thermopulsation, intense pulsed light therapy, and radiofrequency have age-specific considerations, whereas low-level light therapy can be an option for patients as young as 16.

Dr. Davison concluded that successful dry eye management in younger generations requires consistent protocols, age-appropriate language and visual aids in patient and family education, and regular follow-up. She also recommended tools such as the Think Dirty app, or making clean beauty products available through the practice—whether that’s in person or through an online platform.

“Young patients may resist treatment recommendations,” Dr. Davison said, “so build rapport and explain long-term consequences clearly.” ODs can also connect patients with medication assistance programs, provide coupons, or offer assistance with prior authorization processes to make treatment accessible.

References

1. Stapleton F, Velez FG, Lau C, Wolffsohn JS. Dry eye disease in the young: a narrative review. Ocul Surf. 2024;31:11-20. doi:10.1016/j.jtos.2023.12.001

2. Parikh M, Sicks LA, Pang Y. Body mass index, diet, and outdoor activity linked with meibomian gland abnormalities in children. Optom Vis Sci. 2024;101(9):542-546. doi:10.1097/OPX.0000000000002155

3. Wang MTM, Muntz A, Lim J, et al. Ageing and the natural history of dry eye disease: a prospective registry-based cross-sectional study. Ocul Surf. 2020;18(4):736-741. doi:10.1016/j.jtos.2020.07.003

4. Abusamak M, Al Zoubi S, Alomari AF, et al. Ocular adverse events associated with eye makeup: a cosmetovigilance-based cross-sectional study of prevalence and predictors among Jordanian women. Front Public Health. 2025;13:1681656. doi:10.3389/fpubh.2025.1681656