Dry Eye Syndrome, Diabetes & Neuropathy

How-to-maintain-healthy-eyes1

Diabetes Mellitus has been long associated risk factor for Dry Eye Syndrome (DES). The prevalence of DES has been reported up to 54% [1]. DES compromises quality of life because it induces ocular discomfort and visual disturbance and maybe complicated by corneal epithelial defects, erosion’s or ulcers.

In children with type 1 diabetes, there is reduced tear production and tear film stability compared to non-diabetic controls. In addition, 7% of children with diabetes were found to have dry eye compared to 0% of age-matched controls.

Symptoms of Dry Eye

  • Discomfort
  • Dryness
  • Burning
  • Stinging
  • Grittiness
  • Foreign Body Sensation
  • Eye fatigue
  • Vision disturbance (i.e., blurriness)

These symptoms are not trivial and dry eye has a significant impact on quality of life. A recent study of over 500 people found that even after controlling for factors such as age, hypertension and diabetes, people with dry eye had significantly more problems with reading, using a computer, watching television and driving both during the day and at night.

Poor glycemic control and duration of diabetes are correlated with the severity of dry eye. Reduced tear production has been found in people with diabetes compared to those who do not have diabetes. Diabetic retinopathy is correlated with a decline in tear film function.

Neuropathy & DES

A recent study has shown that among the various forms of diabetic neuropathies, chronic sensorimotor distal symmetric polyneuropathy (PN) is the most common form and may manifest with symptoms while sensory and motor deficits are detected. The cornea is one of the most densely innervated parts of the human body containing myelinated A-δ and unmyelinated C fibers, deriving its innervation from the ophthalmic division of the trigeminal nerve. Recent data suggested that patients with PN have corneal nerve fiber damage and reduced corneal sensitivity.

DES is particularly common in patients with type 2 diabetes who have PN, and it is associated with reduced corneal sensitivity. It is suggest that patients with PN be screened for DES and probably treated long-term for the prevention of ocular surface damage. For further information on this study please click here 

Treatment

Dry eye is a very common problem in people with diabetes, with as many as 1 out of every 2 people affected. The symptoms have a significant impact on patient’s quality of life affecting everyday activities such as reading and driving.

Eye drops are one of the mainstays of therapy however, 50% of patients will choose an incorrect type of drop when they go to the pharmacy so education is key in communicating the need to choose drops specifically designed for dry eye sufferers and not redness relievers or allergy drops.

When choosing a dry eye treatment drop, patients should be directed towards a high-performance drop to provide immediate patient comfort, rapid symptom relief, extended protection for the eye and the ability to improve visual performance.

Diabetic Retina Screening in Ireland

Anybody with Type 1 or Type 2 diabetes, aged 12 and older and living in Ireland, will be invited to take part in Diabetic Retina Screening if they are on the Diabetic RetinaScreen register. For further information please click here

References: 

[1] Manaviat MRRashidi M, Afkhami-Ardekani MShoja MR. Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients. BMC Ophthalmol 2008;8:10. DOI: 10.1186/1471-2415-8-10