Although dry eye syndrome (DES) and allergic conjunctivitis (AC) are two different conditions, they share some of the symptoms and can significantly influence school performance, work productivity, and quality of life of the pediatric population. Akil, Celik, Ulas, and Kara (2015) point out that AC can assumingly lead to the tear film dysfunction; since children report symptoms of DES not as frequently as adults, it challenges the clinician’s ability to provide the right diagnosis. Thus, DES remains overlooked in children.
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Furthermore, unlike in other studies, Akil et al. (2015) point out that ocular allergy might be more common in the pediatrics population than DES; AC can create an environment that leads to the dry ocular surface. The authors also indicate that the tear film BUT is closely correlated with a patient’s perception of the severity of the disease (Akil et al., 2015). It should also be noted that clinical findings indicate that subjective symptoms of the dry eye are not related to objective findings in the patient. Thus, children’s complaints about the signs of DES do not explicitly indicate that they have DES; however, they might have the dry ocular surface caused by other factors that they confuse with DES.
The authors also point out that “a long-term allergic disease with a chronic traumatic factor on the corneal epithelium could be related to keratoconus” (Akil et al., 2015, p. 470). Furthermore, chronic AC can also be included in the risk factors for myopic refractive error. As it can be seen, AC can be related to various diseases in children, including severe and progressing conditions; it can also be complicated by DES, which is frequently hard to diagnose due to a patient’s unawareness of the condition. Artificial tears can improve the discussed conditions.
Cushing Syndrome in Pediatrics
Cushing syndrome is rather rare in children; according to Stratakis (2012), 2 to 5 cases per million people per year are registered, and only 10% of those occur in children. The common cause of Cushing syndrome in children is the chronic administration of glucocorticoids or ACTH, whereas glucocorticoids are used quite frequently for treatment of various pulmonary, dermatologic, autoimmune, and other diseases.
The most common symptoms include weight gain and lack of height gain, headaches, facial plethora, hirsutism, and delayed sexual development. A low-dose dexamethasone suppression test or a 24-hour urinary free cortisol (UFC) excretion are suitable types of testing for diagnosing Cushing syndrome (Stratakis, 2012).
Almost all patients with an ACTH-secreting pituitary adenoma or Cushing disease will be referred to transsphenoidal surgery (TSS), which is effective in 90% of cases. Treatment failure can happen due to a macroadenoma or a small tumor in the cavernous sinus. Postoperative complications can vary and include transient diabetes insipidus and/or, in some cases, syndrome of inappropriate antidiuretic hormone secretion, as well as “hypogonadism, bleeding, infection (meningitis), and pituitary apoplexy” (Stratakis, 2012, p. 798). It is important to remember that pharmacotherapy can also be used in treating Cushing syndrome if other interventions were unable to help or in ectopic ACTH secretion when it is impossible to identify the source. Mitotane, metyrapone, ketoconazole, and trilostane are suggested as possible medications for controlling hypercortisolism. Nevertheless, if the source of ACTH secretion can be identified, surgical resection of the tumor is the recommended intervention. If the tumor cannot be located at first, annual screenings are necessary. Bilateral adrenalectomy is suggested if neither of the two interventions suggested above is effective or can be performed.
Akil, H., Celik, F., Ulas, F., & Kara, I. S. (2015). Dry eye syndrome and allergic conjunctivitis in the pediatric population. Middle East African Journal of Ophthalmology, 22(4), 467-471.
Stratakis, C. A. (2012). Cushing syndrome in pediatrics. Endocrinology and Metabolism Clinics of North America, 41(4), 793-803.