Diabetes mellitus has been identified as one of the leading systemic risk factors for Dry Eye Syndrome (DES). An increasing prevalence of diabetes-associated DES has been reported in recent years, the reported prevalence being 15–33 per cent in those over 65 years of age, which increases with age. This condition can even lead to eye damage and vision loss if it’s not treated on time. Let’s learn more about this in detail.
The discomforts of dry eye patients may have a burning sensation, foreign body sensation, stickiness, watering, red eye, photophobia, and blurring of vision. It has been seen that a gritty sensation is the most prominent symptom followed by the abnormalities of the tear film in patients with diabetes-related DES. Severe cases may give rise to ocular complications such as Keratoepitheliopathy and keratitis. These issues will need to be addressed by healthcare professionals.
The causes of dry eye development include peripheral neuropathy, excessive blood sugar, insulin insufficiency, inflammation, and autonomic dysfunction. Diabetic patients’ neuropathy may disrupt the lacrimal gland’s autonomic regulation. It has been demonstrated that sorbitol buildup may lead to structural and functional lacrimal gland damage and dysfunction, which would reduce tear production.
Also, tear film dysfunction has been found to be closely associated with dry eye syndrome. Human tear film comprises three layers:
Diabetes mellitus-related dry eye syndrome (meibomian gland dysfunction, eyelid problems, low blink rate) can cause both aqueous tear deficiency and evaporative dry eye.
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Additionally, diabetes mellitus is a risk factor for corneal epithelial abnormalities. The hyperglycemia-related ocular problems that are linked to DES include trophic ulcers, persistent epithelial defects, recurrent corneal erosions, and superficial punctate keratopathy.
The duration of diabetes appears to have a significant influence on the prevalence of dry eye. Duration of diabetes of over 10 years has been shown to have a strong association with dry eye. The state of control of diabetes is the second factor that is significantly associated with dry eye syndrome. Patients with poor glycemic control have a higher degree of dry eye. Also, dry eye syndrome in patients with type 2 diabetes mellitus is significantly associated with increasing age.
Significant associations have been identified between diabetic retinopathy (DR) and dry eye syndrome. Diabetic retinopathy is caused by damage to the blood vessels in the tissue at the back of the eye (retina). The severity of dry eye is dependent on the duration and treatment.
The early diagnosis and treatment of dry eye are essential to avoid complications. The current treatment regimens for diabetic and non-diabetic dry eye patients are essentially the same. The application of artificial tears is to improve symptoms, artificial tears temporarily improve blurred vision.
Also read: Prediabetes vs diabetes: Know how one is different from another
The most widely used anti-inflammatory drugs are corticosteroids, nonsteroidal anti-inflammatory drugs, cyclosporin A, tacrolimus, and autologous blood serum eye drops. Topical corticosteroids reduce the signs, symptoms, and level of inflammation in dry eyes and prevent corneal epithelial damage.
In clinical practice, diabetics undergo regular examinations. It is wise to examine the ocular surface and tear function also, as a routine diabetic ophthalmic assessment and follow-up. Furthermore, preservative-free artificial tears and short-term anti-inflammatory drugs are recommended to improve the hyperosmolar state of tears and reduce the local inflammatory reaction, especially in patients with a long duration of diabetes and poor glycemic control.
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