Introduction
Diabetes mellitus has been identified as one of the leading systemic risk factors in dry eye syndrome.1 Other common risk factor is female of post-menopausal age.2
Meibomian gland dysfunction is characterized by terminal duct obstruction and/or quantitative and qualitative changes in glandular secretion which leads to increased tear evaporation, thus causing dry eye. This is one of the leading causes of dry eye.3 Insulin and sex hormone plays important role in maintenance of normal meibomian glad function.2
Materials and Methods
A retrospective study was carried out in a total of 200 patients with ocular discomfort, with history of Type 2 diabetes mellitus attending the OPD, Department of ophthalmology in Dr. B.R. Ambedkar medical college over a period of 1 year.
The diabetic state was determined either by history of medication or abnormal random blood sugar >200mg/dl or HBA1C>6.5% or fasting blood sugar>126mg/dl.
Exclusion criteria
Patients with thyroid eye disease
Patients on medications like antihistamines and antidepressants.
Post cataract surgery (within 6 months)
The patients were assessed for Meibomian gland dysfunction under slit-lamp examination.
Meibomian gland dysfunction was assessed for volume and viscosity by expression of the meibomian duct.
Table 1
Meibomian gland expression scale for volume
|
Grade |
Volume |
|
1 |
Normal volume: Just covers orifices |
|
2 |
Increased 2-3 times the normal volume |
|
3 |
Increased more than 3 times the normal volume |
|
4 |
Increased to 10 times the normal volume |
Table 2
Meibomian gland expression scale for viscosity
|
Grade |
Viscosity |
|
1 |
Normal, Clear, may have few particles |
|
2 |
Opaque with normal viscosity |
|
3 |
Opaque with Increased viscosity |
|
4 |
Severe thickening (tooth paste like) |
The examination for the dry eye was done using schirmer’s test and tear break up time
Statistical analysis
Mean, median, standard deviation, ranges were evaluated for continuous variables and for categorical variables, frequency and percentages were recorded. Chi-square test and ANOVA test were also used whenever necessary Independent t test was used to compare mean between the two group. P value of less than 0.05 within 95% CI was considered statistically significant
Discussion
Studies by Seifart and Strempel concluded that 70% of type 2 diabetics have proven dry eye disease. They also found that higher HBA1C values, greater the severity of dry eye disease.4
Ding et al. reported that in diabetic patients, hyperglycemia is one of the pathogenic factors causing common cause of dry eye.5
A study conducted by R.P. Shamsheer and Cynthia Arunachalam shows that the Meibomian gland dysfunction is an important cause of dry eye. This may be one of the causes for increased prevalence of dry eye in Diabetics.3
A study by Dr Jitendra kumar, Dr Preeti chaubey and Dr vijay Pratap concluded that the prevalence of Meibomian gland dysfunction in diabetic population was 56%, MGD is an important pre disposer for Dry eye.6
A study by Li et al,7 Kumar et al,6 Rathnakumar et al8 reported that the symptoms of MGD in type 2 Diabetes were highly significant especially burning and dryness.
A study by Igor Kaiserman MD,9 Sandrajohnna G10 and D.A Schaumberg11 showed that patients with MGD shows meibum expressibility abnormality, found more significantly in patients with type 2 diabetes mellitus.
Conclusion
Our study revealed high correlation between type 2 diabetes mellitus and meibomian gland dysfunction with dry eye.
Meibomian gland dysfunction is an important cause of dry eye and the frequency of the more severe form is greater in diabetics.
This may be one of the causes for the increased prevalence of dry eye in diabetics.
It should be noted at an early stage and treated appropriately in order to prevent more severe eye complications.
Therefore, examination of the meibomian gland is necessary, especially in long-term cases of diabetes mellitus.
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