Abstract
Background: Ocular surface disorders in diabetes mellitus have gained significant attention in recent years, as there is increased reporting of the association of dry eye and diminished corneal sensitivity in these patients. However there is a wide variation in the reported prevalence rates, and a detailed ocular surface evaluation is still not routinely performed for all diabetic patients. We decided to undertake this study to study the prevalence of dry eye and corneal sensitivity in patients with and without type 2 diabetes mellitus, and to look for evidence of any association of these two conditions with diabetic retinopathy
Materials and Methods: This was a cross sectional study undertaken in patients presenting to the ophthalmology outpatient department. Patients above the age of 40 years who did not have any condition other than type 2 diabetes mellitus that could influence dry eye an corneal sensitivity were taken up for the study. Specific evaluation included a history of symptoms related to dry eye using the 5-Item Dry Eye Questionnaire, and then tear film evaluation, tear film break up time, fluorescein and lissamine green staining and Schirmer I test and corneal sensitivity testing with a Cochet-Bonnet esthesiometer.
Results: The prevalence of dry eye among diabetics was 48.9% and diminished corneal sensitivity was 28.9% as compared to 5.6% for both among the non-diabetics. There was a significant association with age and duration of diabetes but not with retinopathy.
Conclusion: A detailed ocular surface evaluation is recommended for all patients with diabetes to detect early evidence of ocular surface disorders so that institution of appropriate management may be undertaken at the earliest.
Keywords: Dry eye, diabetes, corneal sensitivity, corneal sensation, retinopathy.
References
- The impact of diabetes on corneal nerve morphology and ocular surface integrity - Science Direct [Inter-net]. [cited 2018 Jan 19]. Available from: https://www.sciencedirect.com/science/article/pii/S1542012417300162
- Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004 May;27:1047–53.
- Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo C-K, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15:276–83.
- Manaviat MR, Rashidi M, Afkhami-Ardekani M, Shoja MR. Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients. BMC Ophthalmol. 2008;8:10.
- Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol. 2000;118:1264–8.
- Seifart U, Strempel I. The dry eye and diabetes mellitus. Ophthalmol Z Dtsch Ophthalmol Ges. 1994;91:235–9.
- Tripathy K, Chawla R, Sharma YR, Venkatesh P, Vohra R. Corneal changes in diabetes mellitus. Times. 2015;20:55–8.
- Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017 Jul 1;15:539–74.
- Dogru M, Katakami C, Inoue M. Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus. Ophthalmology. 2001;108:586–92.
- Ozdemir M, Buyukbese M, Cetinkaya A, Ozdemir G. Risk factors for ocular surface disorders in patients with diabetes mellitus. Diabetes Res Clin Pract. 2003;59:195–9.
- Nepp J, Abela C, Polzer I, Derbolav A, Wedrich A. Is there a correlation between the severity of diabetic retinopathy and keratoconjunctivitis sicca? Cornea. 2000;19:487–91.
- Aljarousha M, Badarudin NE, Azemin MZC. Comparison of dry eye parameters between diabetics and non-diabetics in district of Kuantan, Pahang. Malays J Med Sci MJMS. 2016;23:72.
- Shaikh R, Ameen J. Prevalence of dry eye disease in type 2 diabetic patients and its co-relation with the duration, glycemic control and retinopathy. Al Ameen J Med Sci. 2015;8:225–9.
- Khurana G, Khurana D, Jain R. Dry Eye in Patients With Diabetic Retinopathy: A Clinical Study. Off Sci J Delhi Ophthalmol Soc. 2016 Dec 24;27:190–3.
- Gao Y, Zhang Y, Ru Y-S, Wang X-W, Yang J-Z, Li C-H, et al. Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy. Int J Ophthalmol. 2015;8:358.
- Saito J, Enoki M, Hara M, Morishige N, Chikama T, Nishida T. Correlation of Corneal Sensation, but not of Basal or Reflex Tear Secretion, With the Stage of Diabetic Retinopathy. Cornea. 2003 Jan;22:15.
- Singh P, Karmacharya S, Rizyal A. Dry Eye Syndrome and Type II Diabetes Mellitus. Nepal Med Coll J. 2016;18:111–5.
- Li HY, Pang GX, Xu ZZ. [Tear film function of patients with type 2 diabetes]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2004 Dec;26:682–6.
- Kesarwani D, Rizvi SWA, Khan AA, Amitava AK, Vasenwala SM, Siddiqui Z. Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population. Indian J Ophthalmol. 2017 Apr;65:301–4.
Corresponding Author
Dr Annapurna Kumar
Department of Ophthalmology,
Sri Venkateshwaraa Medical College Hospital & Research Centre
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.154
