Exploring the Role of Ocular Surface Disease in the Development of Pediatric Astigmatism

Abstract

Background: Ocular surface disease may accompany pediatric refractive disorders through tear-film instability, ocular allergy, and habitual eye rubbing; however, its relationship with clinically significant astigmatism remains insufficiently characterized in Pakistani children. Objective: To determine whether ocular surface disease and related clinical factors were associated with astigmatism among children aged 5–14 years. Methods: This case-control study included 160 children attending ophthalmology services in Peshawar, Pakistan, comprising 80 children with astigmatism of at least 1.00 diopter and 80 controls with cylinder power below 0.50 diopter. Visual acuity, refraction, slit-lamp findings, tear-film break-up time, ocular symptoms, screen exposure, and eye rubbing were assessed. Group differences were evaluated using appropriate comparative tests, and crude odds ratios with 95% confidence intervals were calculated. Results: Ocular surface disease was present in 62.5% of children with astigmatism and 28.8% of controls (OR, 4.13; 95% CI, 2.13–8.01). Allergic conjunctivitis, dry eye disease, and meibomian gland dysfunction were more frequent among cases. Frequent eye rubbing occurred in 58.8% of cases and 22.5% of controls (OR, 4.91; 95% CI, 2.47–9.76). Mean tear-film break-up time was lower in the astigmatism group by 3.80 seconds (95% CI, −4.54 to −3.06). Conclusion: Ocular surface abnormalities, eye rubbing, and tear-film instability were associated with pediatric astigmatism, although causation and temporality cannot be inferred