Diabetes May Increase Ocular Surface Disease Symptoms

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Researchers reviewed the disease’s effect on both tear osmolarity and ocular surface disease index questionnaire scores.

Patients with diabetes have significantly higher ocular discomfort symptoms scores than patients without diabetes, according to study results published in Clinical Optometry. The research also found that tear osmolarity did not significantly differ among controlled and uncontrolled patients with diabetes.

Diabetes is a well-known risk factor for dry eye syndrome, the investigators report. In this study, they aimed to determine the influence of type 2 diabetes mellitus on tear osmolarity, utilizing the TearLab® Osmolarity System (TearLab). In addition, investigators explored the relationship between tear film osmolarity and ocular surface discomfort in patients with controlled and uncontrolled diabetes.

A total of 20 patients (age range: 20-70 years, 100% men) with type 2 diabetes mellitus, and a control group of 40 participants (age range: 18-43 years, 100% men) were enrolled. Information on ocular discomfort symptoms was obtained via Ocular Surface Disease Index (OSDI) questionnaire. 

The researchers found that the mean tear osmolarity was 297±8.00 and 296±11 mOsm/L for controlled and uncontrolled diabetic patients, while the mean tear osmolarity in the control group was 299±8.00 mOsm/L. Based on these data, tear osmolarity showed no significant differences between patients with diabetes and the control group.  

OSDI scores were significantly higher in patients with diabetes vs those in the control group, indicating that diabetes is associated with greater ocular discomfort than normal eyes. Contrary to previous research, no significant association was found between tear osmolarity and OSDI scores.

The researchers speculate that ocular surface damage and tear film instability may play an essential role in furthering the progression of ocular discomfort symptoms among patients with diabetes. They also propose that alternations in tear film parameters may be associated more with diabetic severity rather than duration. 

“There are still many unanswered questions about the relationship between tear osmolarity and the duration of diabetes mellitus,” the investigators conclude. 


Abusharha A, Alsaqar A, Fagehi R, et al. Evaluation of tear film osmolarity among diabetic patients using a tearlab osmometer. Clin Optom. Published online September 1, 2021. doi:10.2147/OPTO.S325768