Not All Dry Eye Questionnaires Are For Children

Mother and daughter on a medical appointment with ophthalmologist
A study measured reliability of several known subjective dry eye tests within the pediatric population .

Dry eye disease is diagnosed through a combination of detailed case history and signs seen through an examination. While several subjective questionnaires aim to assist in this process, they have all been designed for adult patients. As a result,, limited research shows  the efficacy of subjective dry eye questionnaires in the pediatric population. 

A study published in Ophthalmic & Physical Optics looks into the efficacy of several different questionnaires in measuring dry eye symptoms and children. The research shows that tools such as the dry eye questionnaire 5 (DEQ-5) and instant ocular symptoms survey (IOSS) can be reliable in the pediatric setting, while some questionnaires contained terms and language unrecognizable to most pediatric patients.

The study recruited 62 participants, 25 males, and 37 females, all between 6 years and 15 years of age. Participants were asked to complete 6 questionnaires twice in random order. Questionnaires that were examined included the symptoms assessment in dry eye (SANDE), numerical scales rating (NRS), ocular surface disease index (OSDI)  ocular comfort index (OCI), and DEQ-5. The number, and age, of participants requiring assistance, repeatability, and inter-class correlation coefficient (ICC) were examined.

The results show a completion time of less than 2 minutes for each individual questionnaire with younger participants taking longer to complete (P ≤ .01) and 48 participants (P≤.001) requiring more assistance with at least 1 questionnaire and older children (13 years to 15 years old) only requiring assistance with OSDI and NRS. Meanwhile, participants required more assistance with OSDI, NRS, and SANDEE (P ≤.02). The items that included the terms “gritty” and “foreign body sensation” also required more help; 77% of participants in OSDI and 100% of participants in OCI required assistance with the term “gritty” and 92% of participants in NRS required help with “foreign body sensation.” The repeatability was similar for all questionnaires and ICC was moderate to excellent.

Ultimately, the study found that the DEQ-5 and the IOSS were recommended for younger children but found that SANDI, OSDI, and NRS, could reliably be used in pediatric eye care


Chidi-Egboka NC, Golebiowski B, Lee SY, Vi M, Jalbert I. Dry eye symptoms in children: can we reliably measure them? Ophthalmic Physiol Opt. Published online November 22, 2020. doi: 10.1111/opo.12762