Introduction: Diabetes Mellitus is one of the major health problems in developed and developing countries and it affects the organs due to micro-vasculopathy and neuropathy.  Dryness of eye is also a finding frequently found and aggravated in diabetic patients. Although it appears to be a trivial complaint, but it can hamper day to day activities due to the discomfort caused by its symptoms.

Aim: The aim of this study was to estimate the presence of dry eye disease in patients having diabetes mellitus and to correlate dry eye disease with the stages of diabetic retinopathy.

Materials and Methods: 200 Patients having type 2 diabetes mellitus were evaluated in this observational, cross sectional hospital based study using subjective and objective parameters like Ocular surface disease index questionnaire, tear film break up time, Schirmer’s test, fluorescein staining, impression cytology, indirect ophthalmoscopy using ETDRS criteria.

Results: There was a significant correlation between dry eye disease, diabetic retinopathy and HbA1c

Conclusion: In conclusion, the results of the present study indicate that the diabetic subjects have an elevated frequency of dry eye disease (71.5% in this study).Hence examination for dry eye should be an integral part of the ocular assessment of patients with diabetes mellitus.

1. International Diabetes Federation Diabetes Atlas, hird ed Brussels. 2006. www.eatlas.idf.org
2. Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye 2006;20(3):315–8
3. Alves Mde C, Carvalheira JB, Módulo CM, Rocha EM. Tear film and ocular surface changes in diabetes mellitus. Arq Bras Oftalmol 2008;71(6 Suppl):96-103.
4. Lockwood A, Hope-Ross M, Chell P. Neurotrophic keratopathy and diabetes mellitus. Eye (Lond) 2006;20(7):837-9.
5. Nora B. The Incidence of Dry Eye Disease Related to Long Term Diabetes Mellitus Tip 2. JOJ Case Stud 2017;1(5):555571.
6. Pflugfelder SC, Tseng SC, Yoshino K, Monroy D, Felix C. Correlation of goblet cell density and mucosal epithelial membrane mucin expression with rose bengal staining in patients with ocular irritation. Ophthalmology 1997;104 (2):223.
7. Contreras-Ruiz L, Ghosh-Mitra A, Shatos MA, Dartt DA, Masli S. Modulation of conjunctival goblet cell function by inflammation cytokines. Mediators Inflamm 2013:636812.
8. Manaviat MR, Rashidi M, Afkhami-Ardekani M, Shoja MR. Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients. BMC Ophthalmol 2008;8:10.
9. Achtsidis V, Eleftheriadou I, Kozanidou E. Dry Eye Syndrome in Subjects With Diabetes and Association With Neuropathy. Diabetes Care 2014;37:e210–e211.
10. Ozcura F, Aydin S, Helvaci MR.Ocular surface disease index for the diagnosis of dry eye syndrome.Ocul Immunol Inflamm. 2007;15(5):389-93.
11. Al Wadani FA, Nambiar R, Abdul Wahhab KM,Al Asbali T, Nambiar A, Rahaman AU. Reliability and utility of impression cytology in the diagnosis of dry eye. Niger J Ophthalmol 2016;24:51-6.
12. Behrens A, Doyle JJ, Stern L. Dysfunctional tear syndrome. A Delphi approach to treatment recommendations. Cornea 2006;25:90-7.
13. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:786-806.
14. Najafi L, Malek M, Valojerdi AE. Dry eye and its correlation to diabetes microvascular complications in people with type 2 diabetes mellitus. J Diabetes Complications 2013;27(5):459-62.
15. Dogru M, Katakami C, Inoue M. Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus. Ophthalmology 2001;108:586-92.
16. Ozdemir M, Buyukbese MA, Cetinkaya A, Ozdemir G. Risk factors for ocular surface disorders in patients with diabetes mellitus. Diabetes Res Clin Pract 2003;59:195-99.
17. Inoue K, Kato S, Ohara C, Numaga J, Amanto S, Oshika T. Ocular and systemic factors relevant to diabetic keratoepithelio-pathy. Cornea 2001;20:798-801.
18. Cousen P, Cockett P, Bemett H, Swa K, Dhillon B. Tear production andcorneal sensitivity in diabetes. J Diabetes Complications 2007;21:371-3.
19. Seifart U, Strempel I. The dry eye syndrome and diabetes mellitus. Ophthalmologe 1994;91(2):235-9.
20. Jahbuawala M, Agashe AP. A clinical study of prevalence of dry eyes in diabetes and diabetic retinopathy. IJGMP 2014;3(2):31-6.
21. Shaikh R. Prevalence of dry eye disease in type 2 diabetic patients and its co-relation with the duration, glycemic control and retinopathy. Al Ameen J Med Sci 2015; 8(3):225-9.
22. Devi RSU, Gowda MSS. Dry Eye in Diabetes Mellitus Patients and its Relationship with Diabetic Retinopathy. Int J Sci Stud 2016;4(8):67-72.

Dr Prachi Shukla

Assistant Professor, Department of Opthalmomlogy, Muzaffarnagar Medical College, Muzaffarnagar, UP, India