Dry Eye Disease is a very common occurrence in patients with diabetes. While most optometrists are rightly concerned with educating diabetic patients about potential blindness from diabetic retinopathy, it’s important to also address the front surface of the eye. It’s here that Dry Eye Disease (DED) occurs.
Many patients have experienced dry eye over the course of their lifetime. DED, however, is more chronic in nature--it happens often and over a longer course of time. It may be persistent or it may come and go. Symptoms of DED include burning, itching, redness, tearing, foreign body sensation, and pain of varying degrees. Dry Eye Disease also can affect visual function. Even mild to moderate forms of DED can cause blurry vision or fluctuating vision that may be relieved by blinking or use of artificial tears.
While clinical experience shows that DED is experienced by many people in general, studies show that diabetics are especially prone to dry eye. Research reports 50-90% of diabetics may have dry eye of some severity. A 2018 study also showed that 51% of diabetics with DED are undiagnosed. When we put these two stats together we can see that not only do a lot of diabetic patients have dry eye disease, but about half have not been diagnosed or treated.
But why is dry eye disease so prevalent in diabetes? The answer lies in a combination of factors. First, we know that diabetes is a vascular disease by nature---it affects blood vessel quality and function. As such, diabetes affects the very small blood vessels that supply the lacrimal gland, which is the gland that produces and secretes tears or moisture onto the surface of the eye. This causes less moisture to be released. Secondly, research indicates that diabetes reduces the sensitivity of nerves on the front of the eye to detect dryness. If the nerves are not as good at detecting reduced moisture, they will have less ability to trigger the tear gland to produce moisture to help the situation. Research has also shown that diabetes damages cells on the front surface of the eye, called Goblet cells. Goblet cells help secrete mucin onto the eye which gives more stability to the moisture layer. Less mucin means more dryness.
It’s important for patients to know that DED can be addressed and treated successfully. Dry eye does not have to be something that is just accepted and/or ignored. At Coastal Vision, our optometrists recommend and prescribe a broad range of treatments for DED, depending on the severity of the disease. We all know about artificial tears, which are abundantly available over-the-counter (OTC). But, most successful treatments of DED move beyond OTC options to more customized solutions. “Tear saver” plugs gently inserted in drainage ducts are simple and effective long-term treatments for many patients. Prescription medications such as Restasis and Xiidra are also very effective in increasing eye moisture, and they are administered with a low risk of side effects. In certain situations, prescription anti-inflammatory drops may give optimal relief of DED. Newer options for the treatment of DED are also available with more coming on every year. There is an exciting pipeline of more novel treatments in the near future. Finding the right option or combination of options is the goal of our optometrists and meeting that goal requires in-depth evaluation and discussion with patients about symptoms, quality-of-life issues, and cost/insurance concerns.
It’s important that optometrists and diabetic patients have a good discussion about dry eye disease, no matter the range or severity of symptoms. With such a high correlation between dry eye and diabetes, there exists a huge opportunity to improve quality of life and visual outcomes. And, with so many safe treatments for the disease available, dry eyes doesn’t have to be something accepted as a part of life---relief is possible through a good partnership between optometrist and patient.