Dry eye associated with diabetes

Eye Care Awareness Month runs from 21 September to 18 October. In light of this, Dr Chrissie Cockinos explains why dry eye is so common in people living with diabetes.

Diabetes has a number of associated eye conditions: ocular muscle palsies, blepharitis, dry eye, corneal ulceration, changes in refraction, early cataracts and retinal disease.

Sadly, diabetes is becoming more common than ever before. The World Health Organisation (WHO) predicts that there will be 370 million diabetes patients by the year 2030. This is double the number of people living with diabetes registered in 2000.

Why is dry eye common in diabetes patients?

Some studies report dry eye in more than 50% of diabetic patients. People with dry experience discomfort, grittiness, sensitivity to light, redness and a foreign body sensation of the eyes. Sometimes vision becomes blurry. One of the most common causes of dry eye disease is blepharitis (infection and/or inflammation of the eyelids). This is very common in diabetic patients.

Causes of dry eye in people living with diabetes

Hyperglycaemia and insulin resistance can result in neuropathy. The corneal nerves can be affected by long-term diabetes and this may, via the trigeminal nerve and facial nerves, affect the way the lacrimal gland produces tears. This may result in dry eye.

Neurotrophic (insensitive) corneas often result from diabetes. This nerve damage interrupts normal tear development pathways.

Insulin also has a role in tear production.

Inflammation releases certain chemicals, called cytokines, in the body. These chemicals can also damage tear producing cells in the conjunctiva and lacrimal gland.

Sequelae of dry eye

Apart from the frustration of suffering from dry eye, people living with diabetes have a higher incidence of corneal ulceration. This is due to the lack of protection to the eye by a normal tear film, increased blepharitis incidence (a source of bacteria) and insensitivity of the cornea.

Treating your dry eye

  • Topical treatment
  1. Eyelid hygiene to clear blepharitis. A good eyelid cleanser, preferably with tea tree is advisable.
  2. Topical lubricant eye drops and lubricant ointments at night.
  3. Visit your eye doctor annually.
  4. The inflammation of your eyes may require additional treatment and extra measures with cortisone eye drops or ointments.
  5. You may even require lacrimal plugs to be inserted.
  • General
  1. Check your HbA1c and blood pressure regularly via your doctor.
  2. Follow a good diet consisting of protein, vegetables, especially leafy greens, and oily fish like salmon and mackerel.
  3. Exercise regularly. Walk 20 minutes daily.
  4. Take Omega 3 supplements.

MEET OUR EXPERT - Dr Chrissie Cockinos

Dr Chrissie Cockinos (B.Sc (Hons) MBChB (Pret) MMed (Ophth) (Wits)) is an ophthalmologist in Sandton, Gauteng. She completed a masters dissertation in corneal ulceration. She has a special interest in laser eye surgery; cataract microincision, using monofocal and multifocal intraocular lenses; medical retina (diabetes and macular degeneration); surgical retina (retinal detachment and macula surgery) and glaucoma.