How Diabetes Affects the Eye
Author(s): Kalpana Suresh*
Vol. 2, No. 5 (2005-11 - 2005-12)
Diabetes Mellitus is a metabolic disorder. Persons affected by diabetes have increased levels of sugar in their blood which will affect many organs in the body. Treatment is by a three pronged approach of diet control, exercise, and drugs. Uncontrolled diabetes causes deleterious effects on almost all parts of the body 1. The eye in particular is very vulnerable to the effect of diabetes.
Diabetes can affect all parts of the eye from the lids to the retina 2. All diabetics are more prone than normal individuals to have allergic responses in the eye, which manifest as itching and swelling of lids along with stickiness. Dust and pollen are the factors behind allergy. This allergy will be greatly reduced if the blood sugar levels are kept under strict control. Many anti-allergic drops are available which will give relief from the symptoms. A word of caution is that these medications must be used only under medical supervision.
It is a common experience that patients continue to use eye care medications prescribed for one time use by a practitioner. They need to be educated that no eye drops or ointments should be used beyond the duration of prescription. It should be emphasized that with passage of time such medications may become contaminated with microbes and lead to complications. (Ed)
Lids:
Diabetics are more prone to develope lid infections such as stye [lid boils]. Increased blood sugar and tissue sugar levels make these tissues less able to ward off infections.
Spectacles:
Uncontrolled sugar levels can change glass powers rapidly and drastically. So much so that a person needing frequent change of glasses should routinely be checked for blood sugar. Strict control of diabetes will prevent this complication.
Cataract:
All diabetics, in spite of good sugar control, tend to develop cataract slightly earlier than in normal persons. If the blood sugar is not controlled properly they tend to develop cataract much earlier. In very poorly controlled diabetics, cataract can develop in a matter of weeks. Whatever the cause of cataract it can be treated by surgery and implantation of an intraocular lens. The new modality of suture-less small incision surgery with foldable intraocular lens is very suitable for diabetic individuals.
All the above disorders can be treated at any stage and normalcy restored, though it would be better to prevent them from occurring.
Diabetic Retinopathy:
Diabetic affliction of the retina, which is known as diabetic - retinopathy, is far more serious. This condition is irreversible and treatment is always directed at prevention and containment. In persons with diabetes the blood vessels tend to thicken and the internal passage becomes narrow 3. With narrowing of the blood vessels blood flows sluggishly. These problems are more in the retina than any other part of the body 4. With reduced blood flow the retina gets less oxygen than necessary. This caused blood products to leak from the blood vessels into the retina and causes swelling. Swelling of the retina results in slow reduction of vision. If left untreated, further leak of blood itself occurs and vision is further reduced. This reduction of vision cannot be rectified. Any treatment will only maintain vision at the same level. Thus it is very important that this condition be diagnosed very early even before reduction of vision occurs and proper treatment is started. Treatment for this condition is by Argon laser. This laser treatment is applied to the leaking areas and the leak is stopped. First a test called FFA [fundus fluorescein angiography] is done to find out the leaking areas and then laser is applied to treat these areas. Early treatment is necessary to prevent loss or reduction of vision.
The important part of treatment for diabetic retinopathy is regular examination and proper follow up. Any diabetic needs a yearly eye examination. Persons with early diabetic retinopathy need eye examination twice a year. Even after laser treatment [photocoagulation] the patient should be examined every six months.
Regular examination and proper follow up are vital to management of diabetic retinopathy. All diabetics need yearly eye examination. Persons with early diabetic retinopathy need eye examination twice a year. Even after laser treatment [photocoagulation] the patient should be examined every six months.
Glaucoma:
Glaucoma refers to increased intraocular pressure along with defects in visual field and changes in the optic nerve. Diabetic individuals tend to develop glaucoma more commonly than others. Glaucoma is not caused by increased sugar but is inherited along with diabetes. All diabetic persons should be routinely screened for glaucoma and treated if necessary.
Nerve Palsies:
Diabetes may affect the third cranial nerve. The paralysis of the third cranial nerve leads to complete closure of the eye with limitation of eye movements. It can also cause ischaemia of optic nerve leading to visual loss.
Golden Rules for Patients with Diabetes Mellitus:
- Good diabetic control
- Yearly / half-yearly eye examination
- Laser treatment for retinopathy as and when necessary
- No self medication.
References
- Towler HMA, Patterson JA, Lightman S: Diabetes and the eye. CD ROM, BMJ publishing group, 1996.
- Swamura M: Ocular manifestations of systemic disease, (Blaustein, BH, ed) 1994: 189-191
- Jalali S and Das TP: Diabetic Retinopathy: In: Modern Ophthalmology (Dutta L C ed.), 1994: 610-628
- Frank NR, Bresnik GH, Davis MD: Etiologic mechanisms in diabetic retinitis; Retina. Vol II, Stephen Ryan, 1989: 301 – 402
Diabetes – Lid diseases
Chalazion
Blepharitis
Diabetic Retinopathy
a) Non-proliferative
b) Proliferative
* M.S.,F.R.C.S (Glasgow)
Associate Professorof Ophthalmology,
SRMC & RI (DU), Porur, Chennai-600116
Diabetes Mellitus is a metabolic disorder. Persons affected by diabetes have increased levels of sugar in their blood which will affect many organs in the body. Treatment is by a three pronged approach of diet control, exercise, and drugs. Uncontrolled diabetes causes deleterious effects on almost all parts of the body 1. The eye in particular is very vulnerable to the effect of diabetes.
Diabetes can affect all parts of the eye from the lids to the retina 2. All diabetics are more prone than normal individuals to have allergic responses in the eye, which manifest as itching and swelling of lids along with stickiness. Dust and pollen are the factors behind allergy. This allergy will be greatly reduced if the blood sugar levels are kept under strict control. Many anti-allergic drops are available which will give relief from the symptoms. A word of caution is that these medications must be used only under medical supervision.
It is a common experience that patients continue to use eye care medications prescribed for one time use by a practitioner. They need to be educated that no eye drops or ointments should be used beyond the duration of prescription. It should be emphasized that with passage of time such medications may become contaminated with microbes and lead to complications. (Ed)
Lids:
Diabetics are more prone to develope lid infections such as stye [lid boils]. Increased blood sugar and tissue sugar levels make these tissues less able to ward off infections.
Spectacles:
Uncontrolled sugar levels can change glass powers rapidly and drastically. So much so that a person needing frequent change of glasses should routinely be checked for blood sugar. Strict control of diabetes will prevent this complication.
Cataract:
All diabetics, in spite of good sugar control, tend to develop cataract slightly earlier than in normal persons. If the blood sugar is not controlled properly they tend to develop cataract much earlier. In very poorly controlled diabetics, cataract can develop in a matter of weeks. Whatever the cause of cataract it can be treated by surgery and implantation of an intraocular lens. The new modality of suture-less small incision surgery with foldable intraocular lens is very suitable for diabetic individuals.
All the above disorders can be treated at any stage and normalcy restored, though it would be better to prevent them from occurring.
Diabetic Retinopathy:
Diabetic affliction of the retina, which is known as diabetic - retinopathy, is far more serious. This condition is irreversible and treatment is always directed at prevention and containment. In persons with diabetes the blood vessels tend to thicken and the internal passage becomes narrow 3. With narrowing of the blood vessels blood flows sluggishly. These problems are more in the retina than any other part of the body 4. With reduced blood flow the retina gets less oxygen than necessary. This caused blood products to leak from the blood vessels into the retina and causes swelling. Swelling of the retina results in slow reduction of vision. If left untreated, further leak of blood itself occurs and vision is further reduced. This reduction of vision cannot be rectified. Any treatment will only maintain vision at the same level. Thus it is very important that this condition be diagnosed very early even before reduction of vision occurs and proper treatment is started. Treatment for this condition is by Argon laser. This laser treatment is applied to the leaking areas and the leak is stopped. First a test called FFA [fundus fluorescein angiography] is done to find out the leaking areas and then laser is applied to treat these areas. Early treatment is necessary to prevent loss or reduction of vision.
The important part of treatment for diabetic retinopathy is regular examination and proper follow up. Any diabetic needs a yearly eye examination. Persons with early diabetic retinopathy need eye examination twice a year. Even after laser treatment [photocoagulation] the patient should be examined every six months.
Regular examination and proper follow up are vital to management of diabetic retinopathy. All diabetics need yearly eye examination. Persons with early diabetic retinopathy need eye examination twice a year. Even after laser treatment [photocoagulation] the patient should be examined every six months.
Glaucoma:
Glaucoma refers to increased intraocular pressure along with defects in visual field and changes in the optic nerve. Diabetic individuals tend to develop glaucoma more commonly than others. Glaucoma is not caused by increased sugar but is inherited along with diabetes. All diabetic persons should be routinely screened for glaucoma and treated if necessary.
Nerve Palsies:
Diabetes may affect the third cranial nerve. The paralysis of the third cranial nerve leads to complete closure of the eye with limitation of eye movements. It can also cause ischaemia of optic nerve leading to visual loss.
Golden Rules for Patients with Diabetes Mellitus:
- Good diabetic control
- Yearly / half-yearly eye examination
- Laser treatment for retinopathy as and when necessary
- No self medication.
References
- Towler HMA, Patterson JA, Lightman S: Diabetes and the eye. CD ROM, BMJ publishing group, 1996.
- Swamura M: Ocular manifestations of systemic disease, (Blaustein, BH, ed) 1994: 189-191
- Jalali S and Das TP: Diabetic Retinopathy: In: Modern Ophthalmology (Dutta L C ed.), 1994: 610-628
- Frank NR, Bresnik GH, Davis MD: Etiologic mechanisms in diabetic retinitis; Retina. Vol II, Stephen Ryan, 1989: 301 – 402
Diabetes – Lid diseases
Chalazion
Blepharitis
Diabetic Retinopathy
a) Non-proliferative
b) Proliferative
* M.S.,F.R.C.S (Glasgow)
Associate Professorof Ophthalmology,
SRMC & RI (DU), Porur, Chennai-600116