A common but rarely discussed eye complication of diabetes is dry eye syndrome. According to the American Diabetes Association, 54 percent of people with diabetes suffer from dry eyes.
Though the condition may sound harmless, experts say it should be taken as seriously as other diabetic eye complications like retinopathy, cataract, and glaucoma. They say dry eye syndrome is a common complication of both type 1 and type 2 diabetes due to high blood sugar levels.
Does diabetes cause dry eyes?
Dr Vinod Abichandani, senior diabetes and endocrine physician, Ahmedabad, says insulin plays a critical role in the function of the lacrimal gland, which produces watery parts of our tears. Inadequate insulin levels in people with diabetes can affect its functioning, thus reducing tear production. “Diabetes also affects oil glands in our eyelids that prevent the watery part of our tears from evaporating too quickly after each blink. These glands are responsible for producing tears and maintaining healthy moisture levels in our eyes,” he adds.
High blood glucose can also damage nerves throughout the eyes, including in the lacrimal gland and cornea. “It leads to limited blood flow to these parts of the eye, leading to decreased tear production (quantity of tears) as well as decreased tear adhesion to the eye (quality of tears),” he explains.
Dry eyes symptoms
Dr B L Sujatha Rathod, Director, Minto Ophthalmic Hospital, Bangalore, says there can be a number of symptoms of dry eyes but the most prominent one is tearing. “One may wonder how their eyes can be ‘dry’ despite producing plenty of tears. The irritation in the eye due to unhealthy tear film stimulates the brain to produce tears to help counteract the irritation. But this is insufficient to fix the overall problem of dry eyes,” she explains. She adds due to this reason, dry eye syndrome is more appropriately termed ‘Tear Film Dysfunction’. Other symptoms of dry eye syndrome or tear film dysfunction include:
- Dry, gritty or burning sensation in the eyes
- Watery or teary eyes
- Mucus that makes eyes feel ‘glued shut’ while sleeping
- Feeling of something being there in the eye
- Light sensitivity
- Blurry or fluctuating vision
- Eye fatigue
- Frequent blinking
- Caking of the eyelashes (usually worse upon waking)
Our tears protect the surface of the eyes from infection and hence, dry eyes can lead to eye infections. Experts also say if left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcers and vision loss, affecting the quality of life.
Many people with diabetes may need to use artificial tears (eye drops, preferably ones without a redness-reliever component in them) every day to lubricate dry eyes and provide adequate moisture. Dr Rathod says the current treatment options for dry eyes are essentially the same for both diabetics and non-diabetics. She says longer-acting agents such as artificial tear gel and ointments and tear conserving interventions like punctal plugs (a tiny device placed in eye’s tear ducts to retain tears and keep eyes moist) can be useful. She further suggests that nighttime masks/goggles, warm compresses, eyelash and eyelid scrubs, anti-inflammatory drugs, immunomodulators, and topical ophthalmic steroids can help control the inflammation associated with the condition. “Oral flaxseed oil or fish oil supplements (2000 mg/day) have also been found useful in alleviating symptoms and decreasing the frequency of topical agents anecdotally,” she adds.
Autologous serum tears (artificial tears mixed with the person’s serum) and heat therapy can be particularly helpful in advanced dry eye cases.
Can dry eyes be stopped?
The condition can be temporary or permanent. Dr Abichandani says, “Temporary dry eye can be caused by exposure to allergens or staring at a screen for too long. It can last for a few hours to months. Long-term dry eye syndrome can be caused by elevated blood sugar levels as it damages delicate nerves that support the ocular structures.”
In either case, a person should seek treatment for dry eye and any underlying condition that may be causing it, he adds.
Measures to prevent and manage dry eyes
Experts recommend following measures to prevent dry eyes:
- Managing blood sugar through exercise, diet, and medications.
- Regular checkups include examination of the ocular surface and tear function.
- Use eye drops to help lubricate the eyes.
- Use preservative-free artificial tears and anti-inflammatory drugs under medical supervision.
- Studies have shown 54 percent of people with diabetes have dry eyes.
- Diabetes can affect the functioning of the lacrimal gland, which produces tears.
- It also affects oil glands in our eyelids that help maintain healthy moisture levels in the eyes.
- High sugar levels can damage delicate nerves in the eyes including in the lacrimal gland and cornea.
- If left untreated, dry eyes can cause severe complications like inflammation, abrasion of the corneal surface, corneal ulcers and vision loss.
- Managing sugar levels and regular checkups can help prevent and manage dry eyes.