Ocular surface disease in patients with diabetic peripheral neuropathy

Abstract

Purpose To analyze clinical signs and symptoms of ocular surface disease in patients with diabetes mellitus (DM), based on severity of diabetic peripheral neuropathy (DPN). Methods This cross-sectional study included participants who were carefully phenotyped by a multidisciplinary team and categorized into groups based on severity of DPN. All study participants underwent ophthalmic evaluation and completed the Ocular Surface Disease Index (OSDI) and Visual Function Questionnaire (VFQ-25). Results The 34 study participants were: healthy controls (n=9), patients with DM and mild or no DPN (n=16), and patients with DM and severe DPN (n=9). Tear osmolarity was increased, and corneal nerve fiber length was decreased, with increasing severity of DPN. In addition, patients with DM were found to have decreased Schirmer’s test values when compared to healthy controls. No statistically significant differences were found between groups in OSDI, tear break-up time, or corneal sensitivity. No statistically significant correlations were noted between the OSDI or VFQ-25 scores and clinical signs of dry eyes. Conclusions This study demonstrates increased clinical signs of ocular surface disease, but not an increase in subjective symptoms of dry eyes, with increasing severity of DPN. Furthermore, no significant correlation was found between OSDI scores and clinical signs of dry eye. A periodic evaluation of the ocular surface is important for patients with DM, in addition to retinopathy screening, as they may be asymptomatic but have severe dry eye disease, which can lead to further ocular surface complications such as corneal ulceration.

Diabetic complications in the cornea

“…Diabetic corneal neuropathy, corneal autofluorescence [possibly due to the accumulation of advanced glycation end products (AGEs)], and epithelial fragility are all augmented in patients with DR (Chang et al, 1995; Janiec et al, 1995; Saini and Mittal, 1996a; Van Schaik et al, 1999; Bikbova et al, 2012; DeMill et al, 2016; Calvo-Maroto et al, 2016). Diabetics often have low tear secretion and dry eye syndrome (Inoue et al, 2001; Yoon et al, 2004; Cousen et al, 2007; Manaviat et al, 2008; Beckman, 2014).…”

“…However, these changes are rarely diagnosed (Herse, 1988; Wylegała et al, 2006). Major attention is paid to retina despite the proposed inclusion of ocular surface assessment during eye examination in diabetic patients (Ben Osman et al, 1995; Aiello et al, 1998; DeMill et al, 2016). Currently, 18% of corneas transplanted in the United States come from diabetic donors (Lass et al, 2015), which may not be beneficial for recipients due to lasting epigenetic changes in these corneas.…”

Association of dry eye disease with psychiatric or neurological disorders in elderly patients

“…Misra et al70 reported significant impairment of tear film stability and lipid layer quality in patients with diabetes mellitus. The severity of diabetic PN is closely aligned with the severity of dry eye signs, including tear film parameters 70,71. However, due to corneal hypoesthesia associated with diabetic PN, patients are often asymptomatic even in the presence of serious ocular surface damage 71.…”

Cornea and its changes in diabetes mellitus: the review

“…Особенности анатомического строения позволяют использовать роговицу для оценки изменений перифери-ческой нервной системы, возникающих при СД [13][14][15][16].…”

“…При диабете страдают структурные слои роговицы: слезная пленка, передний и задний эпителий, строма, боуменовая и десцеметовая мембраны, обеспечивающие качество зрения. Глазные изменения при СД вторичны и возникают на основе про-грессирования основного заболевания [13,25,26].…”