Dry Eye In Diabetics
OPHTHALMOLOGY NEWS by Vanessa Caceres EyeWorld Contributing Editor Diagnosis and treatment pearls to help these patients Tear duct plugs or cauterization can be considered in patients with inadequate tear flow as measured by the Schirmer test, to help keep the ocular surface more moist Meibomian gland dysfunction leads to an evaporative type of dry-eye syndrome; patients complain of pain, discomfort, and burning; symptoms are usually out of proportion with the signs Source: Esen K. Akpek, M.D. Are your diabetic patients regularly screened for dry eye? If they’re not, they should be, say a number of ophthalmologists who treat diabetic dry-eye patients. “Most internists send diabetic patients to a retinal specialist once or twice a year to look at the back of the eye, but you never hear about a check by a corneal specialist,” said Robert Latkany, M.D., founder and director, Dry Eye Clinic, New York Eye and Ear Infirmary, New York. Although the retinal exam that screens for diabetic retinopathy is crucial, regular corneal exams are also important for diabetics, Dr. Latkany said. Here’s why: Roughly half of diabetic patients have dry eye, as reported by a number of studies. However, these same patients often do not feel their symptoms. “Some of the worst dry-eye patients don’t complain,” Dr. Latkany said. “They have a compromised epithelium, which can lead to infections. They have to be watched closely.” Esen K. Akpek, M.D., director, Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University, Baltimore, likens it to the common problems diabetics have with sores or blisters that they do not feel on other parts of their body. This lack of sensation also occurs in the eye in the form of neurotrophic keratitis. It’s not entir Continue reading >>
Sore Dry Eyes In Diabetes
Introduction Sore eyes are particularly common in diabetes for various reasons. minor irritation is probably a side effect of all the medications, such as the blood pressure medication. This is common and not serious. part of the reason for this is that people may develop blepharitis, which is inflammation/infection of the eyelids you may have 'dry eyes'. Dry eyes is explained here in detail. if you have had diabetes a long time, and have diabetic neuropathy, this can lead to very serious problems Your eyes may feel tired, scratchy or gritty, as though there is something in them. They also be a little itchy, and they may be red. See animation. They may feel more sore in the wind, or any dry hot atmosphere. Contact lenses, or any thing that reduces blinking may make 'dry eyes' more uncomfortable, such as watching TV or a computer screen, or sewing. Stopping the blood pressure medication can lead to major problems, and it is much safer to put up with and treat the sore eyes than stop the medication. Sore and perhaps slightly dry eyes..treatment There are two parts to the treatment. the lubricants are discussed here. treat the blepharitis, described here. This is mainly eyelid cleaning. Moderately dry eyes..treatment Again, there are two parts to the treatment. the lubricants ... gels are best. treat the blepharitis, described here. This is mainly mainly eyelid cleaning. more severely dry eyes are best treated with preservative free eye drops Severely dry eyes/diabetic corneal neuropathy There are several parts to the treatment. the lubricants are discussed here. treat the blepharitis, described here plugs may be needed Very dry eyes are discussed here. diabetic corneal neuropathy is discussed here. Treatment for the severest cases includes eyelid closure to allow the corn Continue reading >>
Dry Eye In Diabetic Patients
Purpose To compare the prevalence of keratoconjunctivitis sicca (KCS) in a prospective cohort of 22,382 diabetic patients with that in the general population. Methods setting: A district of Israel’s largest health maintenance organization. study population: We followed the electronic medical records of all patients in the district older than 50 years (159,634 patients) between January 1 and December 31, 2003. Of those, 22,382 (14.0%) had diabetes. observation procedure: The proportion of ocular lubrication consumers was compared among diabetic and nondiabetic patients. All HbA1c laboratory tests performed by the diabetic patients were documented (41,910 tests), and glycemic control was correlated with the consumption of ocular lubrication. main outcome measures: Ocular lubrication use by diabetic patients compared with the general population and the relationship between glycemic control and ocular lubrication use. Results After age and gender adjustment, a significantly higher percentage of diabetic patients (20.6%) received ocular lubrication, compared with nondiabetic patients (13.8%, P < .001). The difference was significant for all age groups and for both sexes (P < .001). A similar significant difference was prominent between diabetic and nondiabetic patients aged 60 to 89 years who were frequent users of ocular lubrication. Ocular lubrication consumption increased with poorer glycemic control (mean annual HbA1c levels). Multivariate analysis revealed this effect to be independent of age, sex, place of birth, or place of residence. Conclusions KCS is significantly more common among diabetic patients. Poor glycemic control correlates with increased artificial tear use in diabetic patients. To access this article, please choose from the options below Continue reading >>
Dry Eyes? | Diabetes Forum The Global Diabetes Community
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Hi I have been type one for around 35yrs. In that time I have been screened for retinopathy for at least the last 10yrs. I am now undergoing some lasering treatment. For as long as I can remember my eyes have always been red/blood shot but no one at the eye clinic has questioned me about this or mentioned it could even be related to my diabetes. On the the copy of the clinic results which are sent to my doctor as well as myself after each visit there's a line on them noting " OCT Dry eyes" They have never felt sore or dry to me but they do look like I haven't had a nights sleep in years Looking back I have been pretty depressed for ages so I haven't really been bothered about how they looked or to ask about them. In a recent forum post a link was put up which along with explaining retinopathy and its treatments it also had a page about dry eyes. I was just wondering if anyone else has had any experience of the dry eyes and is it a treatable or a permanent side effect of my diabetes? Should I see my GP regarding them in the meantime or the eye clinic? as I had some lasering last week and am due to go back in 7 to 8 weeks for more ? The link to the retinopathy info... I occasionally suffer from dry eyes - nothing to do with diabetes, but an infection of the small moisturising pores on the edge of the eyelid. It's called blepharitis. This can make your eyes feel hot and itchy, produce a lot of mucus and you wake up with that sticky yellowish goo around your eyelids. I think you would know about this if you had it - but worth mentioning the name to your specialist. My optician didn't spot it until I asked about it by name! Dry eyes with me mean great diff Continue reading >>
Dry Eye Syndrome In Subjects With Diabetes And Association With Neuropathy
Diabetes mellitus has been identified as a risk factor for dry eye syndrome (DES). The prevalence of DES in diabetes has been reported to be up to 54.3% (1). DES compromises quality of life because it induces ocular discomfort and visual disturbance and may be complicated by corneal epithelial defects, erosions, or ulcers. Therefore, it is recognized as a growing public health problem that should be diagnosed and treated (1). 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 (2). 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 (3). According to the International Dry Eye WorkShop (DEWS), the reduced corneal sensitivity favors the occurrence of DES in two ways: first by decreasing the reflex-induced lacrimal secretion and second by reducing the blink rate and increasing evaporative tear loss (4). Although PN and DES are common in diabetes, the relationship between them is not known. The research hypothesis we tested herein was that subjects with PN may more often have DES as a result of reduced corneal sensitivity and impaired balance of tear production/evaporation. A total of 61 subjects with type 2 diabetes and 38 control subjects were recruited in this cross-sectional study. PN was assessed by using the neuropathy disability and neuropathy symptom scores (5). We used the DEWS recommendation to assess DES (4). Moreover, the Schirmer I test, tear film br Continue reading >>
Dry Eye Syndrome And Two Commonly Overlooked Causes Of Dry Eyes – Part I
Dry eye syndrome is currently a very prominent topic in optometry. Increased awareness has caused a surge in articles written on the topic and research performed in the field. However, there are still patients slipping through the cracks that are even more at risk for dry eye syndrome or dry eye disease (DED) than the general population. Most optometrists are aware of the most common systemic conditions and other causes of dry eyes including, Sjogren’s syndrome, Rheumatoid arthritis, lupus, and thyroid-related conditions. Diabetes and glaucoma are two conditions that should be at the top of that list and every optometrists’ mind considering the increased risk for dry eye syndrome. Dry Eye Syndrome and Diabetes According to the American Diabetic Association, 29.1 million Americans, or 9.3% of the population, had diabetes in the last year reported (2012) and that number is on the rise.1 Diabetes is also one of the leading causes of blindness in persons aged 20-74. Cataracts and diabetic retinopathy are the most thought of cause of blindness; however, ocular surface complications such as superficial punctate keratopathy, trophic ulceration, and persistent and recurrent epithelial erosions need to be realized as a common reason for decreased vision and blindness.2 Secondary complications from diabetes-induced dry eye syndrome include corneal scarring and bacterial infections. There are three proposed mechanisms of DED complications related to systemic diabetes:3 Neuropathy Metabolic dysfunction Abnormal lacrimal secretions 1) Neuropathy and Dry Eye Syndrome Decreased corneal sensitivity through neuropathy of the ophthalmic branch of the Trigeminal nerve (CNV) and the long ciliary nerves leads to decrease feedback, decreased healing and basement membrane abnormalities. T Continue reading >>
Diabetes Induced Dry Eye
You may know that high blood glucose levels over the years can lead to nerve damage and heart disease. You may also know that diabetes can damage the retinas in your eyes. But did you know that diabetes may cause another problem for your eyes called “dry eye”? Diabetes induced dry eye isn’t at all comfortable. Your eyes feel dry and may have a burning sensation or an irritation that gets worse as the day goes on. Dry eye happens because of nerve damage and the loss of feeling on your cornea (the front part of the eye). WHAT IS DRY EYE? The first thing that happens when an eye becomes dry is that the tears lose water and become too salty. Just like the stinging and burning that happens when a wound comes in contact with salt, when your tears become too salty they cause stinging and burning in your eye. As eyes become drier, the salt that is left behind makes them feel sandy and gritty. Dry eye is one of the most common conditions affecting the eyes. This is true regardless of whether you have diabetes. Almost 14 percent of people over the age of 40 have dry eye, and the chances you’ll get it increase as you get older. This is true because there are so many causes of dry eye. Anything that slows down your body’s ability to produce tears or that makes tears dry up may cause dry eye. The ability to make tears can be slowed down by: Certain medications such as diuretics, beta blockers and antihistamines; and Any condition that decreases sensation on the surface of your eye or makes the eye numb. These can include long-term hard contact lens wear, LASIK eye surgery, certain viral infections of the cornea and diabetes. Increased evaporation that causes drying up of your tears can also cause dry eye. This happens when eyes are more exposed to natural causes, such as b Continue reading >>
Diabetes And Dry Eye: The Forgotten Connection
12th Annual Diabetes Report At least half of patients with diabetes also exhibit dry eye symptoms. Assess these patients from the start. Goal Statement: Diabetes is often associated with several significant ocular conditions, such as retinopathy, refractive changes, cataracts, nerve palsies, glaucoma and macular edema. However, one of the most common ocular complications associated with diabetes is dry eye. This article traces the complex relationship between diabetes and dry eye, and explores several potential management strategies for controlling both conditions. Faculty/Editorial Board: Milton M. Hom, O.D. Credit Statement: This course is COPE approved for 2 hours of CE credit. COPE ID is 28593-GL. Check with your local state licensing board to see if this counts toward your CE requirement for relicensure. Joint-Sponsorship Statement: This continuing education course is joint-sponsored by the Pennsylvania College of Optometry. Disclosure Statement: Dr. Hom is a consultant to Abbott Medical Optics, Allergan, CIBA Vision, CooperVision, Baush + Lomb, Inspire Pharmaceuticals and Essilor. Are we seeing more patients with diabetes today than two decades ago? Yes–– without question. Diabetes used to be just another condition. Now, it is an epidemic. In fact, diabetes is quickly emerging as one of the biggest health-related catastrophes the world has ever witnessed.1 And, the problem is not exclusive to the United States. The World Health Organization (WHO) estimates that there will be 370 million people with diabe tes on the planet by 2030, which is nearly twice the figure reported in 2000.2 In the United States alone, 11.3% of adults have either type 1 or type 2 diabetes.3 Furthermore, the treatment costs are overwhelming. Each year, $174 billion is spent on medication Continue reading >>
Does Diabetes Cause Dry Eyes?
Dry eye syndrome (DES), also known as keratoconjunctivitis sicca, is one of the most commonly diagnosed eye conditions, and people with diabetes are at higher risk for this disorder. In fact, research shows that those of us with diabetes can have up to a 50 percent chance of suffering from dry eye. Dry eye syndrome is almost always a condition affecting both eyes. Symptoms include: a scratchy sensation that feels like fine grains of sand are in the eyes, burning, itching, blurred, or fluctuating vision, light sensitivity, redness, and increased watering of the eyes, despite the name dry eye syndrome. What causes dry eye syndrome? Did you know that tears consist of three layers? Outer oil layer: Prevents evaporation from the surface of the eye. Middle layer: Mostly made of water. Inner mucus layer: Allows the middle, watery layer to adhere to the naturally water repellant surface of the eye. People with dry eyes either don’t produce enough tears or their tears are of poor quality. An abnormality in any of these three layers can result in symptoms of dry eye, and effective treatment depends upon correctly diagnosing which layer(s) are causing the problem. Most cases of dry eye are thought to be due to an insufficient amount of the middle, watery layer, which is normally released by a large tear gland (the lacrimal gland) under the rim of the upper and outer eye socket (some small, accessory tear glands are located within the eyelids as well). Research shows that most cases of dry eye associated with diabetes are caused by insufficient production of tears due to autonomic neuropathy affecting the nerves that control the tear (lacrimal) gland. That is, the same process leading to diabetic peripheral neuropathy—that causes symptoms like tingling or burning in the hands a Continue reading >>
Dry Eye Syndrome In Patients With Diabetes Mellitus: Prevalence, Etiology, And Clinical Characteristics
Go to: 2. Prevalence of Dry Eye Syndrome in Diabetes Mellitus Diabetes mellitus (DM) has been identified as one of the leading systemic risk factors for DES. The reported prevalence of DES in diabetics is 15–33% in those over 65 years of age and increases with age and is 50% more common in women than in men [3]. The incidence of dry eye is correlated with the level of glycated hemoglobin: the higher the level of glycated hemoglobin, the higher the incidence of dry eye [4]. The Beaver Dam Eye Study reported that approximately 20% of dry eyes occurred in individuals with Type 2 diabetes aged between 43 and 86 years. Hom and De Land reported that 53% of patients with either diabetes or borderline diabetes had self-reported, clinically relevant dry eyes [5]. In a hospital-based study, 54% of those with diabetes had DES and there was a significant correlation between DES and the duration of diabetes. This suggests that examination for dry eye should be an integral part of the ocular examination in patients with diabetes [2]. Significant associations have been identified between diabetic retinopathy (DR) and DES. In a hospital-based study, 17.1% of DES in patients with DM was found to have mild nonproliferative diabetic retinopathy (NPDR), 17.1% had moderate NPDR, 11.1% had severe nonproliferative diabetic retinopathy (NPDR), and 25.1% had proliferative diabetic retinopathy (PDR) [6]. DR is also associated with a decrease in tear film function. Tear break-up time (BUT) and Schirmer's test values were significantly decreased in the PDR group compared to the non-DR group while corneal fluorescein staining scores, positive rate of rose Bengal staining, the surface regularity index, and the surface asymmetry index were increased. The concentrations of lactoferrin and tear-speci Continue reading >>
Say Goodbye To Dry Eye
Eye problems, such as diabetic retinopathy and macular edema, are well-known complications of diabetes. Fortunately, these conditions can be treated and even prevented if caught early (which is why getting an annual dilated eye exam is so important for people who have diabetes). What is dry eye? Another eye problem that’s more common in people who have diabetes is dry eye. According to the National Eye Institute, dry eye is a condition in which the eye does not produce tears properly. It can also involve tears not having the right consistency or evaporating too quickly. Tears are necessary to help maintain moisture on the surface of the eye and for clear vision. In many cases the surface of the eye becomes inflamed; if not treated, pain, ulcers, scars, and possibly loss of some vision can occur. Between 10% and 30% of the population suffer from dry eye. One study showed that people who have diabetes have a 50% chance of getting dry eye. What causes dry eye? There are a lot of causes of dry eye, including: Age: The older we get, the drier the eyes can get. Most people over the age of 65 have some degree of dry eye. Gender: Women are more likely to have dry eye than men, thanks to hormonal changes. Medications: Blood pressure medications, birth control pills, antihistamines, decongestants, and antidepressants can reduce tear production. Medical conditions: Having diabetes, rheumatoid arthritis, lupus, and thyroid problems, along with certain eye problems, raise the risk of dry eye. Research shows that dry eye in people with diabetes is typically linked with a type of neuropathy called autonomic neuropathy; this neuropathy can affect the nerves that control tear production. Environment: Dry, windy, or smoky climates increase dry eye risk. Staring at a computer screen all Continue reading >>
Prevalence Of Dry Eyes In Diabetics Compared To Non Diabetics
The purpose is to compare the prevalence of dry eyes in diabetics and non diabetics. This might help identify a group of patients at greater risk for dry eye complications. Diabetics have been shown to have poor ocular surface healing and might benefit from dry eye therapy earlier if they are shown to be at greater risk for dry eyes. Dry eye disease is one of the most common eye problems seen in ophthalmology. Diabetics are at high risk for multiple eye problems, including retinopathy and glaucoma. They also have been shown to have poor ocular surface healing. I would like to evaluate the prevalence of dry eye disease in diabetics to see if they are also at greater risk for the known complications of dry eye disease. If so, they might benefit from early intervention. Study Type : Observational Actual Enrollment : 63 participants Observational Model: Case Control Time Perspective: Cross-Sectional Official Title: Prevalence of Dry Eyes in Diabetics Compared to Non Diabetics Study Start Date : January 2012 Primary Completion Date : June 2012 Study Completion Date : June 2012 Primary Outcome Measures : Conjunctival Staining Score [ Time Frame: at the time of the evaluation ]Conjunctival staining with lissamine green dye is measured at the time of the evaluation on a scale from 0 to 5 using the oxford scoring system, with 5 being the most severe staining. Other Outcome Measures: OSDI Score [ Time Frame: at the time of the exam ]The ocular surface disease index survey in completed at the time of the exam. This scale ranges from 0 to 100 higher scores representing greater disability. Schirmer Score [ Time Frame: at the time of the exam ]The schirmer tear production test with anesthesia is completed at the time of the exam in mm of tear film absorption on the test strip after f Continue reading >>
Dry Eyes With Diabetes Mellitus
The metabolic disorder diabetes mellitus is one of the major public health problems of our time. Around eight million people in Germany suffer from diabetes. Diabetic retinopathy (changes in the retina due to diabetes) is a consequence of diabetes which affects the eye, often accompanied by dry eyes. Diabetes mellitus: when the blood sugar gets out of control Diabetes mellitus is a chronic metabolic disorder in which the body can no longer adequately regulate the blood sugar balance. Therefore, the blood sugar levels of diabetics fluctuate enormously. This has severe repercussions on the whole body, among other things on the eyes. The reason for the restricted regulation of blood sugar is the hormone insulin. Insulin is produced in the pancreas and ensures that the sugar, which goes into the blood from digesting food, is absorbed in the cells. The sugar is then stored in the cells as energy reserves and is released as required. Diabetics produce little or no insulin and in addition, the cells can often react a lot worse to insulin. They develop a resistance. The consequence: the sugar remains in the blood which, in the long run, leads to cell damage and changes in the blood vessels. People afflicted notice high blood sugar levels, for example through a constant urge to urinate and feeling very thirsty. The damage is irreparable and leads to serious consequences for organs and tissue. How strongly diabetes affects the body depends on how well blood sugar levels are managed and how long the disease persists. Diabetic retinopathy: severe changes to the retina due to diabetes Diabetic retinopathy is a disease of the retina and one of the most common causes of blindness in people between 20 and 65. In particular, the fine blood vessels, the capillaries, are affected by high Continue reading >>
Diabetes And Blurry Vision: What You Need To Know
Diabetes and blurry vision Diabetes refers to a complex metabolic disease in which your body either can’t produce insulin, doesn’t produce enough insulin, or simply can’t use it efficiently. All your body’s cells need sugar (glucose) for energy. Insulin helps to break down and deliver sugar to cells throughout your body. Sugar levels build up in your blood if you don’t have enough insulin to break it down. This is known as hyperglycemia. Hyperglycemia can negatively affect every part of your body, including your eyes. Blurry vision is often one of the first warning signs of diabetes. Your vision may be blurry because fluid is leaking into the lens of your eye. This makes the lens swell and change shape. Those changes make it hard for your eyes to focus, so things start to look fuzzy. You may also get blurred vision when you start insulin treatment. This is due to shifting fluids, but it generally resolves after a few weeks. For many people, as blood sugar levels stabilize, so does their vision. How can diabetes cause blurry vision? Diabetic retinopathy is a term that describes retinal disorders caused by diabetes. Some of these disorders include macular edema and proliferative retinopathy. Macular edema is when the macula swells due to leaking fluid. The macula is the part of the retina that gives you sharp central vision. Other symptoms of macular edema include wavy vision and color changes. Proliferative retinopathy is when blood vessels leak into the center of your eye. Blurry vision is one of the signs that this is happening. You may also experience spots or floaters, or have trouble with night vision. Blurry vision can also be a symptom of glaucoma, a disease in which pressure in your eye damages the optic nerve. According to the National Eye Institute, i Continue reading >>
Treating Dry Eye In People With Diabetes
What is dry eye syndrome? Dry eye syndrome is a common problem and is one of the most frequent reasons given for seeking eye care. Patients will complain of eye irritation, fatigue, dryness and visual problems such as blurriness. The causes of dry eye are many but the end result is a disturbance of the tear film due to either decreased tear production or excessive evaporation of tears.(1) 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.(2) The blurriness experienced by people with dry eye when doing activities such as watching television, reading or driving is thought to be due in part to problems with the tear film between blinks. Specifically, the tear film breaks up much faster between blinks in people with dry eye compared to those without dry eye. When the tear film breaks up between blinks, the surface of the eye is exposed and dry areas can occur and lead to dry eye symptoms. In tests that measure the visual acuity between blinks, people with dry eye had a 50% reduction in the rate of visual acuity decay compared to people without dry eye indicating that visual acuity deteriorates faster in dry eye patients.(3) When the impact on patient’s quality of life and visual acuity is taken as a whole, it is apparent why dry eye syndrome is considered a public health problem that requires effective treatment. Dry eye in people wi Continue reading >>
