Diabetes Exacerbates Dry Eye Symptoms, Study Shows

Patients with type 2 diabetes experience more severe dry eye symptoms, including significant lid margin and tear film abnormalities, a new study reveals. This research highlights the critical need for clinicians across specialties to recognize and address diabetes-related ocular surface damage. Early detection and collaborative care between ophthalmologists and endocrinologists are essential for managing these complications and preventing further harm. Photo: Luis Rojas, OD. Click image to enlarge. The prevalence of both dry eye disease (DED) and type 2 diabetes are on the rise globally, and as researchers uncover more about these conditions, the clearer the associations become. According to The Tear Film & Ocular Surface Society Dry Eye Workshop II (DEWS II), diabetes is considered a probable risk factor for DED, but not much is known on its full impact on the ocular surface. Now, a new study published in International Ophthalmology takes a deeper look at the relationship between type 2 diabetes and changes in the lid margin, meibomian glands and tear film in patients with dry eye, concluding that symptoms are more severe in such patients. Chinese researchers performed a single-center, cross-sectional study of 302 eyes from 151 patients diagnosed with dry eye. Participants were divided into two groups: those with type 2 diabetes (n=108) and those without (n=194). Dry eye diagnosis was based on DEWS II criteria, including Ocular Surface Disease Index questionnaire assessment, ocular surface staining, noninvasive tear breakup time (NIBUT) and meibomian gland dysfunction (MGD). Compared with the DED-only group, those with diabetes as well had a higher upper lid margin irregularity, lid margin vascularity, plugging of gland orifices grade, lid margin thickening grade, upper meibomian gland dropout and ciliary hyperemia, and shorter noninvasive breakup time. Blood glucose level also had a significant correlation with tear breakup time, lid margin thickening grade and lower lid margin irregularity. No significant differences were found in tear meniscus height, first breakup location, lipid layer thickness, conjunctival congestion, lower meibomian gland dropout, MG distortion, upper lid margin irregularity and average NIBUT.As noted by the study’s authors in their paper, chronic hyperglycemia in diabetes patients can activate multiple inflammatory pathways on the ocular surface, leading to increased expression of proinflammatory cytokines, which can damage ocular surface cells and destabilize tear film composition and functionality. The study found that diabetes patients with dry eye “exhibited more severe lid margin abnormalities, orifice plugging and tear film instability” compared to those with DED alone,” the authors wrote in their paper, findings consistent with previous studies. “The significant correlation between blood glucose levels and NIBUT suggests that NIBUT could serve as a pertinent metric in the clinical assessment for monitoring the progression and severity of diabetic conditions,” they wrote. “Our study adds to the former studies by providing a comprehensive evaluation of lid margin and meibomian gland changes” in type 2 diabetes patients with dry eye, they continued. While previous studies focused primarily on meibomian gland dysfunction, “our study also assessed tear film stability using NIBUT and evaluated lid margin abnormalities in detail.” Limitations mentioned by the researchers include the inability to rule out the influence of confounding factors in a cross-sectional study. Additionally, lid margin and meibomian gland evaluation was manual as opposed to automated, which may have increased subjectivity to the results, they wrote.Ultimately, this study emphasizes the need for clinicians across specialties to pay attention to diabetes-related ocular surface damage. “Regular examination of the ocular surface in type 2 diabetic patients is quite essential,” the authors concluded. “Collaboration between ophthalmologists and endocrinologists is necessary for early detection, diagnosis and treatment of diabetic ocular surface lesions to prevent more serious ocular surface damage.”Click here for the journal source. Hao Y, Wu B, Feng J, et al. Relationship between type 2 diabetes mellitus and changes of the lid margin, meibomian gland and tear film in dry eye patients: A cross-sectional study. Int Ophthalmol. June 24, 2025. [Epub ahead of print.]