This prospective RCT evaluated whether prophylactic and therapeutic diquafosol 3% (4×/day, started before lens fitting) prevents or treats dry eye in first-time pediatric orthokeratology wearers compared to no additional treatment over 3 months.
At 3 months, the diquafosol group showed significantly better first NIBUT, average NIBUT, tear meniscus height, lipid layer thickness (all P < 0.001), lower OSDI scores (P < 0.05), and better uncorrected visual acuity (P < 0.001); corneal staining was lower only at 1 week (P < 0.05), not at 1 or 3 months. Adverse events were mild and limited to transient discharge (3 children, treatment) and conjunctival congestion (5 eyes, control).
Single-arm control (no sham drops), so masking of participants was not possible. Study was limited to 3 months, leaving long-term efficacy and safety unknown. Only one diquafosol concentration and dosing regimen were tested.
Starting diquafosol 3% before orthokeratology lens fitting—and continuing through wear—improves tear film stability and reduces dry eye symptoms in children. Consider prophylactic use during the prefitting period to optimize the ocular surface before lens wear begins.
