A descriptive cross-sectional study on the dry eye disease in children in Xiamen, China.

OBJECTIVE: To evaluate the clinical characteristics, risk factors, and applicability of three commonly used dry eye disease (DED) questionnaires (OSDI, CDEQ, and COCI) in children and adolescents in Xiamen, China, aiming to provide preliminary descriptive data in DED pediatric population. METHODS: This single-center cross-sectional study included 105 pediatric patients with DED. Demographic data, clinical findings, risk factors, and questionnaire scores were collected. Univariate analysis was used to identify associated factors. Internal consistency was assessed using Cronbach's α, inter-questionnaire correlations using Spearman analysis, and discriminative validity using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Among 105 participants (mean age 7.86 ± 3.13 years; 64.76% male), the majority were elementary school-aged (54.29%). All patients exhibited meibomian gland dysfunction, and 92.38% had mixed-type DED. Age (p = 0.012), BMI (p = 0.067), outdoor activity (p = 0.029), and sleep duration (p = 0.055) were associated with DED subtype or severity. The response rates of the CDEQ and COCI were 100%. All questionnaires showed acceptable internal consistency (Cronbach's α = 0.642-0.919) and moderate correlations. However, none demonstrated significant discriminative ability for DED severity (p > 0.05). CONCLUSION: Given the cross-sectional design, no causal inference can be drawn from these findings. Within this descriptive framework, mixed-type DED with predominant MGD emerged as the main subtype in children in Xiamen. Obesity, limited outdoor activity, and short sleep duration were identified as potential correlates. The CDEQ and COCI showed acceptable feasibility and reliability, while the OSDI demonstrated limited applicability. None of the three questionnaires effectively distinguished severity, underscoring the need for pediatric-specific tools.