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C. Garcher, O. Gualino, F. Brignolle, P. Lafontaine, A. Bron, C. Baudouin; Ocular Surface Changes in Diabetes Mellitus . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3758.
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Purpose: To assess ocular surface disorders in patients with diabetes. Methods: Routine ophthalmic examinations, corneal sensitivity measurements, Schirmer test, Tear Break Up Time (BUT) and fluorescein assessments were performed in patients who suffered from long term diabetes and in control subjects. In the same time, impression cytologies for HLA DR, MUC5 AC and Trefoil factor (TFF) assessments were performed by flow cytometry. General parameters (i.e. glycosylated hemoglobin, duration of diabetes, peripheral neuropathy, status of diabetic retinopathy) were also noted. Results: Ninety six eyes of 48 diabetic patients and 40 eyes of 20 control patients were included. Corneal sensitivity was significantly reduced in diabetic patients with peripheral neuropathy (mean=3.20±0.99) and without peripheral neuropathy (mean=4.32±0.82) in comparison with controls (mean=5.70±0.36)(p<0.001). The presence of a shortened BUT was highly correlated with peripheral neuropathy (p<0.0001) and altered corneal sensitivity (p<0.0001). HLA DR expression was higher than controls in patients suffering from ocular surface disorders and peripheral neuropathy (p=0.02) whereas mucous markers were unchanged. Conclusions: Clinical ocular surface disorders observed during diabetes are closely linked to peripheral neuropathy and reduced corneal sensitivity. Peripheral neuropathy seems to relate to the expression of inflammatory markers but not to mucous secretion.
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