Glaucoma is a leading cause of blindness. It is a multifactorial condition, the risk factors for which are increasingly well defined from large-scale epidemiological studies. One risk factor that remains controversial is the presence of diabetes. It has been proposed that diabetic eyes are at greater risk of injury from external stressors, such as elevated intraocular pressure. Alternatively, diabetes may cause ganglion cell loss, which becomes additive to a glaucomatous ganglion cell injury. Several clinical trials have considered whether a link exists between diabetes and glaucoma. In this review, we outline these studies and consider the causes for their lack of concordant findings. We also review the biochemical and cellular similarities between the two conditions. Moreover, we review the available literature that attempts to answer the question of whether the presence of diabetes increases the risk of developing glaucoma. At present, laboratory studies provide robust evidence for an association between diabetes and glaucoma. Key words: diabetes, dyslipidaemia, ganglion cells, glaucoma, hyperglycaemia, intraocular pressure, retina Diabetes is a leading health priority, as it can cause severe systemic complications, such as retinopathy, neuropathy and nephropathy. This metabolic disorder results from either altered secretion of insulin by the pancreas (type 1 diabetes) or insulin resistance at a cellular level (type 2 diabetes). These changes produce widespread abnormalities in glucose uptake, resulting in hyperglycaemia, as well as abnormal metabolism and formation of lipids (Figure 1), which impact on neurons, blood vessels and glial cells. Indeed, this journal carries an excellent review on glial dysfunction in diabetic eyes.1 Many clinicians will be aware of diabetic retinopathy and its classification, as laid out by the National Health and Medical Research Council Guidelines for the Management of Diabetic Retinopathy. 2 The purpose of this review is not to dwell on the specifics of diabetic retinopathy but to consider whether diabetes predisposes the eye to other disorders, in particular glaucoma.Diabetes has been estimated by the World Health Organization to affect more than 180 million people worldwide. Despite increasing awareness and advances in management of this disease, it is anticipated that the number of sufferers of diabetes will rise to over 360 million by 2030.3 Diabetic eye disease is a leading cause of blindness [4][5][6] in those of working age (aged from 30 to 69 years).7 The Wisconsin Epidemiologic Study of Diabetic Retinopathy reports that both the duration of the disease and its type (1 or 2) affect the chance of expressing retinopathy. 8,9 The prevalence of retinopathy after five years (17 to 29 per cent) increases after 15 years to 78 to 100 per cent.Diabetes is known to increase the risk of other health complications, 10 in particular, cardiovascular problems 11-13 and cerebral ischaemia. 14,15 Of particular interest to eye-care practitioners is the question of whether we should adj...