Korean J Ophthalmol.  2004 Dec;18(2):168-174. 10.3341/kjo.2004.18.2.168.

Changes of Tear Film and Ocular Surface in Diabetes Mellitus

• Yoon KC
• Im SK
• Seo MS

• KMID: 754383
• DOI: http://doi.org/10.3341/kjo.2004.18.2.168

Abstract

This study was performed to investigate the changes of tear film and ocular surface in diabetic patients, as well as the ocular and systemic factors related to these changes. We assessed the scoring of keratoepitheliopathy, corneal sensitivity test, tear film break-up time (BUT), Schirmer test, and conjunctival impression cytology in 94 eyes of 47 patients with noninsulin-dependent diabetes mellitus and in 60 eyes of 30 normal subjects. The degree of keratoepitheliopathy was severe, and the corneal sensitivity, BUT, and tear secretion were significantly reduced in the diabetic patients. Conjunctival impression cytology showed a higher grade of conjunctival squamous metaplasia and lower goblet cell density in the diabetic patients. All parameters were related to the status of metabolic control, diabetic neuropathy, and stage of diabetic retinopathy. We think that diabetic patients with poor metabolic control, neuropathy, and advanced stage of retinopathy should be examined for tear film and ocular surface changes.

Keyword

diabetes mellitus; impression cytology; keratoepitheliopathy; ocular surface; tear film

MeSH Terms

Adult
Aged
Comparative Study
Corneal Diseases/etiology/*metabolism
Diabetes Complications/*metabolism/pathology
Epithelium, Corneal/*metabolism/pathology
Female
Goblet Cells/pathology
Humans
Male
Middle Aged
Risk Factors
Tears/*metabolism

Figure

• 

  Fig. 1 Impression cytology (PAS, ×400). (A) Specimen from a normal subject shows many periodic acid-Schiff positive goblet cells and small, round epithelial cells with a nucleocytoplasmic ratio of 1:1 or 1:2 (squamous metaplasia grade 0). (B) Specimen from a patient with poorly controlled diabetes and peripheral neuropathy shows a loss of goblet cells and large, polygonal epithelial cells with a nucleocytoplasmic ratio of 1:3 or 1:4 (squamous metaplasia grade 2).

Reference

1. Schultz RO, Van Horn DL, Peter MA, Klewin KM, Schutten WH. Diabetic keratopathy. Trans Am Ophthalmol Soc. 1981. 79:180–199.

2. Schultz RO, Matsuda M, Yee RW, Edelhauser HF, Schultz KJ. Corneal endothelial changes in type 1 and type II diabetes mellitus. Am J Ophthalmol. 1984. 98:401–410.

3. Friend J, Thoft RA. The diabetic cornea. Int Ophthalmol Clin. 1984. 24:111–123.

4. Herse PR. A review of manifestations of diabetes mellitus in the anterior eye and cornea. Am J Optom Physiol Optics. 1988. 65:224–230.

5. Chung H, Tolentino FI, Cajita VN, Acosta J, Refojo MF. Reevaluation of corneal complications after closed vitrectomy. Arch Ophthalmol. 1988. 106:916–919.

6. Saini JS, Khandalavla B. Corneal epithelial fragility in diabetes mellitus. Can J Ophthalmol. 1995. 30:142–146.

7. Hatchell DL, Magolan JJ Jr, Besson MJ, Goldman AL, Pederson HJ, Schultz KJ. Damage to the epithelial basement membrane in the corneas of diabetic rabbits. Arch Ophthalmol. 1983. 101:469–471.

8. Inoue K, Kato S, Ohara C, Numaga J, Amano S, Oshika T. Ocular and systemic factors relevant to diabetic keratoepitheliopathy. Cornea. 2001. 20:798–801.

9. Dogru M, Katakami C, Inoue M. Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus. Ophthalmology. 2001. 108:586–592.

10. Miyata K, Amano S, Sawa M, Nishida T. A novel grading method for superficial punctate keratopathy magnitude and its correlation with cornea epithelial permeability. Arch Ophthalmol. 2003. 121:1537–1539.

11. Jones LT. The lacrimal secretory system and its treatment. Am J Ophthalmol. 1966. 62:47–60.

12. Anshu , Munshi MM, Sathe V, Ganar A. Conjunctival impression cytology in contact lens wearers. Cytopathology. 2001. 12:314–320.

13. Nelson JD. Impression cytology. Cornea. 1988. 7:71–81.

14. Nepp J, Abela C, Polzer I, Derbolav A, Wedrich A. Is there a correlation between the severity of diabetic retinopathy and keratoconjunctivitis sicca? Cornea. 2000. 19:487–491.

15. Gekka M, Miyata K, Nagai Y, Nemoto S, Sameshima T, Tanabe T, Maruoka S, Nakahara M, Kato S, Amano S. Corneal epithelial barrier function in diabetic patients. Cornea. 2004. 23:35–37.

16. Saito J, Enoki M, Hara M, Morishige N, Chikama T, Nishida T. Correlation of corneal sensation, but not of basal or reflex secretion, with the stage of diabetic retinopathy. Cornea. 2003. 22:15–18.

17. Kador PF, Kinishita JH. Role of aldose reductase in the development of diabetes associated complications. Am J Med. 1985. 79:suppl 5A. 8–12.

18. Loy A, Lurie KG, Ghosh A, Wilson JM, MacGregor LC, Matschinsky FM. Diabetes and myo-inositol paradox. Diabetes. 1990. 39:1305–1312.

19. Rogell GD. Corneal hypesthesia and retinopathy in diabetes mellitus. Ophthalmology. 1980. 87:229–233.

20. Geobbels M. Tear secretion and tear film function in insulin dependent diabetes. Br J Ophthalmol. 2000. 84:19–21.

21. Aragona P, Giuffrida S, Di Stefano G, Ferreri F, Di Benedetto A, Bucolo C, Cro M. Ocular surface changes in type 1 diabetic patients. Adv Exp Med Biol. 2002. 506:667–672.

22. Ozemir M, Buyukbese MA, Cetinkaya A, Ozemir G. Risk factors for ocular surface disorder in patients with diabetes mellitus. Diabetes Res and Clin Pract. 2003. 59:195–199.