Aim: This study aims to investigate the clinical changes in the ocular surface of patients diagnosed with type II diabetes mellitus.
Methodology: A total of 75 adult patients of both genders with type II diabetes and ocular surface disease, along with a group of healthy subjects, were included in the study. Various tear film stability tests such as tear film break-up time (BUT) test, Schirmer I test, fluorescein dye test, and rose bengal dye test were conducted to assess ocular surface disorders. Additionally, the Ocular Surface Disease Index (OSDI) questionnaire was administered to all enrolled patients. The duration of diabetes, HbA1C levels, and the stage of diabetic retinopathy were also recorded.
Results: Group I comprised 45 males and 30 females, while group II included 35 males and 40 females. Non-proliferative diabetic retinopathy (NPDR) was present in 48 patients, whereas proliferative diabetic retinopathy (PDR) was present in 19 patients, showing a significant difference (P=0.01). The remaining diabetic patients did not exhibit any clinically observable fundus changes of retinopathy during stereoscopic 90 D examination. The average tear function test was 8.22 seconds in group I and 13.1 seconds in group II, whereas the average Schirmer test values were 8.84 mm in group I and 16.5 mm in group II. Fluorescein staining was observed in 8 patients in group I and 2 patients in group II, while pathologic rose bengal staining was positive in 15 patients in group I and 4 patients in group II, demonstrating a significant difference (P<0.05). The average tear film BUT was 9.25 seconds in patients with a duration of diabetes <10 years and 8.17 seconds in those with a duration of diabetes >10 years. Similarly, the average Schirmer test revealed values of 10.31 mm and 6.72 mm, respectively. Patients with good glycemic control exhibited average tear film BUT and Schirmer test values of 10.85 seconds and 10.21 mm, while those with poor glycemic control showed values of 8.30 seconds and 6.82 mm, respectively. In patients with NPDR, the values were 9.53 seconds for tear film BUT and 10.5 mm for the Schirmer test, whereas patients with PDR had values of 7.84 seconds and 7.6 mm, respectively. The average range of OSDI score was 40-60 in group I compared to 0-20 in group II.
Conclusion: Patients diagnosed with diabetes mellitus are more susceptible to developing ocular surface disorders. Furthermore, a longer duration of diabetes and poor glycemic control are associated with increased chronic inflammation of the ocular surface. The stage of diabetic retinopathy shows a direct correlation with the OSDI questionnaire score.
