Prevalence of Dry Eye Syndrome and Diabetic Retinopathy in Type 2 Diabetic Patients

Masoud Reza Manaviat; Maryam Rashidi; Mohammad Afkhami-Ardekani; Mohammad Reza Shoja


BMC Ophthalmol 

In This Article

Abstract and Background

Background: This study was performed to assess the prevalence of dry eye syndrome and diabetic retinopathy (DR) in type 2 diabetic patients and their contributing factors.
Methods: 199 type 2 diabetic patients referred to Yazd Diabetes Research Center were consecutively selected. All Subjects were assessed by questionnaire about other diseases and drugs. Dry eye syndrome was assessed with Tear break up time tests and Schirmer. All the subjects underwent indirect ophthalmoscopy and retinal color photography. DR was graded according to early Treatment Diabetic Retinopathy (ETDRS) criteria.
Results: Of 199 subjects, 108 patients (54.3%) suffer from dry eye syndrome. Although dry eye syndrome was more common in older and female patients, this association was not significant. But there was significantly association between dry eye syndrome and duration of diabetes (P = 0.01). Dry eye syndrome was more frequent in diabetic patients with DR (P = 0.02). DR was found in 140 patients (70.35%), which included 34 patients (17.1%) with mild non proliferative DR (NPDR), 34 patients (17.1%) with moderate NPDR, 22 patients (11.1%) with severe NPDR and 25 patients (25.1%) with proliferative DR (PDR). There were significant relation between age, sex and duration of diabetes and DR.
Conclusion: In this study the prevalence of dry eye syndrome was 54.3%. Diabetes and dry eyes appear to have a common association. Further studies need to be undertaken to establish an etiologic relationship. However, examination for dry eye should be an integral part of the assessment of diabetic eye disease.

Diabetes is one of the most common leading causes of blindness in 20-74-year old persons.[1] Cataract and retinopathy are well-known as ocular complications of diabetes. Recently, problems involving the ocular surface, dry eyes in particular, have been reported in diabetic patients.[1] These patients suffer from a variety of corneal complications including superficial punctuate keratopathy, trophic ulceration, and persistent epithelial defect.[2] Dry eye is an important contributor to these problems. Dry eye syndrome has many causes. One of the most common reasons for dryness is aging process.[4] The mechanism responsible for dry eyes is unclear[5], but autonomic dysfunction may be responsible.[6] Aldose reductase, the first enzyme of the sorbitol pathway, may also be involved. The oral administration of aldose reducetase inhibitors has been shown to improve the tear dynamics significantly.[7] In one study a correlation was found between the glycated hemoglobin (HbA1C) and the presence of dry eye syndrome. The higher the HbA1c values, the higher the rate of dry eye syndrome.[8] In another study founded that diabetic patients had lower values of tear secretion and values of tear break up time test (TBUT) than control group.[9] Jin et al showed that patients with type 2 diabetes tend to develop tear film dysfunction. This study suggests that TBUT should be a routine ophthalmologic test in diabetic patients.[10] Dry eye can lead to vision deficit, scarring and perforation of the cornea and secondary bacterial infection. If this syndrome is diagnosed at first stage and treated, would be protected from its complications.[2] Therefore early diagnosis of dry eye syndrome in diabetic patients is important for beginning of treatment in early stages. Nevertheless studies to evaluate the prevalence of dry eye syndrome in type 2 diabetic patients are lacking. Therefore, we evaluated prevalence of dry eye syndrome in type 2 diabetic patients.


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