Ocular Surface Diseases in Patients With Diabetes

Abstract

Purpose Diabetes is a major cause of ocular morbidity as multiple mechanisms play a role in inducing inflammatory changes in the eye. Diabetic retinopathy is the most common complication and is well-documented. However, in the era of modern medicine, attention is also being focused on ocular surface changes in diabetes. Therefore, this study aimed to determine the association between diabetes and ocular surface diseases. Materials and Methods This is a cross-sectional study examining 320 eyes of 160 patients with diabetes who were grouped according to their duration of diabetes. The symptoms were evaluated using the ocular surface disease index (OSDI) questionnaire. Their recent hemoglobin (Hb) A1c value was recorded. Their external or internal hordeolum, blepharitis, meibomian gland dysfunction, and corneal sensitivity were also evaluated. The tear film was examined using tests, such as Schirmer's test, tear film breakup time (TBUT), tear film meniscus height (TFMH), fluorescein stain, and rose bengal stain. The results were correlated with the duration and control of diabetes. Results The mean age of the study population was 56.60 years comprising 56% (n=89) females and 44% (n=71) males. The mean OSDI scores were 7.9 ± 3.55 and 57 ± 19.22 in patients without dry eye and with severe dry eye, respectively. The study observed OSDI scores were consistently high with diabetes severity. About 67% (n=24) of patients with HbA1c of >8% had dry eyes. Dry eye was found in 68% (n=59) of patients with the duration of diabetes being >10 years. About 23.7% (n=38) had blepharitis, whereas only 4% (n=7) had external or internal hordeolum and 44% (n=86) had different grades of meibomian gland dysfunction. Corneal sensitivity was abnormal in only 12% (n=12) of patients. About 55% (n=86) of patients had varying degrees of dry eye. A statistically significant correlation was found between the severity of dry eye and TBUT, TFMH values, and grades of corneal staining (P < 0.0001). Conclusion This study observed that the incidence of dry eyes was found to be higher when patients had uncontrolled diabetes and diabetes for a longer period. The OSDI scoring system is an important diagnostic tool while examining patients with dry eye. In an ophthalmology clinic, patients with diabetes should always be evaluated for any ocular surface changes when being screened for diabetic retinopathy, and proper guidelines should be implemented to detect changes in the ocular surface system as early as possible so that any long-term complications such as infectious or neurotrophic keratitis may be avoided at an early stage.

Clinical assessment of corneal alterations in endocrine disorders

“…This was comparable to another study by Didenko et al 17 where the prevalence of corneal ulcer in T2DM was 6.6%, recurrent corneal erosion was 8.2% and punctate keratopathy was 21.3%. In our investigation, we found that 26.9% of T2DM patients had reduced corneal sensations, which was higher than the 12% prevalence found in the study by Naik K et al 18 In our investigation, we discovered that the prevalence of dry eye was 14.3% in T1DM, 32% in T2DM, 35% in hypothyroidism and highest (55.6%) in GO. Naik k et al 18 carried out a similar investigation with T1DM and T2DM, wherein dry eye was shown to be more common in T2DM (66 out of 160 cases) than in T1DM (15 out of 160 cases).…”

Immune Fingerprint in Diabetes: Ocular Surface and Retinal Inflammation

“…Chronic hyperglycemia can significantly impact various ocular surface components, including the corneal epithelium, corneal nerves, tear film, endothelium, and conjunctiva [ 84 ]. Abnormalities in the cornea (delayed epithelial wound healing, edema, corneal erosions, neuropathy, decreased sensitivity) and tear film changes have been reported [ 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ]. A healthy cornea depends on the appropriate functioning and communication of epithelial cells, sensory neurons, and resident immune cells, and diabetes disrupts their interaction and cooperation.…”

Effects of Diabetes Mellitus on Corneal Immune Cell Activation and the Development of Keratopathy

“…In the retina, DM induces neovascularization and microvascular damage, causing retinopathy [ 9 , 10 , 11 , 12 ], which is one of the leading causes of vision loss. DM is known to cause ocular surface changes, leading to a higher incidence of ocular surface disease, including dry eye, in diabetic patients [ 13 , 14 , 15 , 16 ]. Additionally, DM is also associated with other ophthalmic disorders, such as glaucoma [ 17 , 18 ] and cataracts [ 10 , 19 ].…”