Author(s): S. Srinivasan1, P. Santhi2, G. Dhamodaran3
Globally, an estimate of 422 million adults are living with diabetes mellitus according to the latest 2016 data from the WHO. In India, as per 2015 data, there were 69.2 million cases of diabetes present. Of these, it remains undiagnosed in more than 30 million people.
Dry Eye Workshop (DEWS) in 2007 improvised the definition for DEWS as follows- “Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. It is accompanied by occurrence of increased osmolality of tear film and inflammation of the ocular surface.”
MATERIALS AND METHODS
In our study, 100 cases of maturity onset of type 2 diabetic patients both male and female between age group 30 and 90 years were studied. All 100 cases of type 2 diabetes patients already on oral antidiabetic drugs, insulin or combined treatment reported to eye OPD directly as well as referred from diabetology and medical OPD and ward were subjected to routine ophthalmological examination including Schirmer's test I, TBUT, corneal sensitivity test, blood sugar fasting and postprandial, blood pressure record, HbA1C in selected cases. Clinical data of all patients, which included sex, age, duration of diabetes, family history of diabetes, BMI as well as a history of other associated hypertension and renal failure were recorded in all patients. HIV association, recent ocular surgery, corneal oedema, viral keratitis, Hansen, post LASIK surgery, meibomian gland dysfunction were excluded from our study.
Sexual prevalence in our study was female with increased prevalence of 60% compared to male of 40%. Age of the patients in the range between 30-40 years 10; 41-50 years 31; 51-60 years 35 and 61-70 years 20 in numbers. In our study, more than 15 years duration of diabetes mellitus 15 cases presented with diabetic retinopathy changes as per ETDRS criteria in the stage of moderate NPDR 11 cases and severe NPDR 2 cases. Mild NPDR changes were present in 11 cases and the duration of diabetes in these individuals between 10-15 years period of type 2 diabetes. With PDR changes, 2 cases were presented with severe dry eye showing less than 5 mm in Schirmer’s test 1. The increased prevalence of dry eye in female is multifactorial causes like old age, postmenopausal reduced oestrogen level.
In our study, there was 15% of DED cases. All of them were more than 15 years duration of diabetes with moderate-to-severe NPDR and PDR with impaired corneal sensation and reduced TBUT values with age group 51-70 years as increased prevalence. Early detection of dry eye in these diabetic mellitus patient will prevent the corneal complications and visual blindness.