Diabetic Corneal Neuropathy

Abstract

Diabetic keratopathy (DK) is a common, but underdiagnosed, ocular complication of diabetes mellitus (DM) that has a significant economic burden. It is characterised by progressive damage of corneal nerves, due to DM-induced chronic hyperglycaemia and its associated metabolic changes. With advances in corneal nerve imaging and quantitative analytic tools, studies have shown that the severity of diabetic corneal neuropathy correlates with the status of diabetic peripheral neuropathy. The corneal nerve plexus is, therefore, considered as an important surrogate marker of diabetic peripheral neuropathy and helps in the evaluation of interventional efficacy in the management of DM. The clinical manifestations of DK depend on the disease severity and vary from decreased corneal sensitivity to sight-threatening corneal infections and neurotrophic ulcers. The severity of diabetic corneal neuropathy and resultant DK determines its management plan, and a step-wise approach is generally suggested. Future work would focus on the exploration of biomarkers for diabetic corneal neuropathy, the development of new treatment for corneal nerve protection, and the improvement in the clinical assessment, as well as current imaging technique and analysis, to help clinicians detect diabetic corneal neuropathy earlier and monitor the sub-clinical progression more reliably.

Opioids and Ocular Surface Pathology: A Literature Review of New Treatments Horizons

“…Diabetes type 1 and 2 produces corneal tissue complications such as decreased corneal epithelial turnover, less tear production, delayed corneal wounds repair, diminishes corneal surface sensitivity, and even generates neuropathy symptoms [ 34 , 35 ]. Enkephalin levels are elevated in the serum of diabetic type 1 humans and animals, and the levels seemed to be consistent with hyperglycemia and time of evolution [ 36 , 37 ].…”

Incidence and Risk Factors of Dry Eye in Children and Adolescents With Diabetes Mellitus: A 3-Year Follow-Up Study

“…A clinical study conducted by Alise et al showed that the degree of reduced corneal sensitivity in adult patients with DM was positively correlated with the severity of dry eye (17). The possible mechanisms involved may be that high-level glycosylated end metabolites may cause metabolic damage to the peripheral corneal nerve (18) and thus, reduce the corneal perceptual sensitivity and tear secretion in patients with DM (19)(20)(21). Additionally, corneal perception is positively correlated with blink reflex (22,23) and the decrease in blink reflex can accelerate tear evaporation and lead to an increase in tear osmotic pressure.…”

Transcriptional Network Analysis Reveals the Role of miR-223-5p During Diabetic Corneal Epithelial Regeneration

“…DM is a common systemic disease with rising prevalence (Markoulli et al, 2018). Disorders caused by DM are a serious public health challenge and financial burden to many countries (Mansoor et al, 2020). As a complication induced by DM, DK has gained increasing attention recently, and can lead to delayed corneal epithelium and nerve regeneration (Li et al, 2020a;Wang et al, 2020a;Li et al, 2020b).…”