The relationship between obesity, insulin resistance, and conjunctival impression cytology

Abstract

Objective: This study was designed to determine whether obesity causes the development of metaplasia in conjunctival epithelial cells. Material and Method: A total of 61 volunteer participants who had no previous history of illness or drug use were involved in this study. Of those, 20 were obese, and 41 were of normal weight. We measured the glucose and insulin values of all volunteers. We also measured the Body Mass Index (BMI) and Homeostasis Model Assessment for Insulin Resistance (HOMA IR). The impression cytology method was used to analyze the conjunctival epithelium cells, and to classify them between Grades 0 to 3 according to the Nelson criteria. Results: There was a certain level of loss of goblet cells on the 90% level as well as squamous metaplasia (Grade 2-3) in 80% of the obese participants and impression cytology was found to be normal in only two patients. The expected results were observed in 56.1% of the control group where the squamous metaplasia rate was nearly 17% (p<0.001). 90.9% of the grade 3 patients were obese. The variables as independent predictors were found to indicate the existence of abnormal cytology in the conjunctiva at various levels; BMI (OR: 1.24; p=0.002) and HOMA IR (OR= 28.6; p= 0.001) in a Model I multivariable regression model, and the existence of obesity (OR: 11.91; p=0.002) and HOMA IR (OR= 15.08; p<0.001) in a Model II multivariable regression model. Conclusion: Obesity was found to be a disorder that causes metaplasia in the conjunctival epithelium cells for the first time.

Eye care providers’ emerging roles in early detection of diabetes and management of diabetic changes to the ocular surface: a review

“…24 51 Patients with obesity (average BMI 38.2±5.8), most of whom would also have been classified as having prediabetes (FPG 108.2±14.1), also showed increased conjunctival metaplasia and goblet cell loss compared with healthy controls. 52 Via a retrospective medical record review, patients with diabetes were more likely to have a diagnosis of blepharitis (type unspecified) compared with controls. 53 The etiology and pathogenesis of reduced tear function in patients with diabetes is likely due to both microvascular and neuropathic changes in lacrimal and Meibomian glands, in addition to reduction in reflex tearing due to decreased corneal sensitivity and nerve dysfunction.…”