Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients

Ji Yoon Kwak; Kyu Ryong Choi; Kyung Eun Han; Roo Min Jun

doi:10.3341/jkos.2019.60.11.1037

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Kwak, Choi, Han, and Jun: Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(11): 1037-1042.

Published online: 19 October 2019

DOI: https://doi.org/10.3341/jkos.2019.60.11.1037

Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients

Ji Yoon Kwak, MD, Kyu Ryong Choi, MD, PhD, Kyung Eun Han, MD, PhD, Roo Min Jun, MD, PhD

Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea.

Address reprint requests to Roo Min Jun, MD, PhD. Department of Ophthalmology, Ewha Womans University Seoul Hospital, #260 Gonghangdae-ro, Gangseo-gu, Seoul 07804, Korea. Tel: 82-2-6986-3280, Fax: 82-2-6986-3275, jrmoph@ewha.ac.kr

Received 2 May 2019 Revised 30 May 2019 Accepted 23 October 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the morphological changes of meibomian glands and dry eye syndrome in patients with type II diabetes.

Methods

The medical records of 72 diabetic patients referred to the ophthalmology clinic for the evaluation of diabetic retinopathy, who had dry eye symptoms, were retrospectively reviewed.

Results

A total of 72 patients, with an age of 56.3 ± 13.3 years, were analyzed. The group with diabetic retinopathy (52 patients) had a significantly lower tear film break-up time (p = 0.046), lower Schirmer's test value (p = 0.005), and higher percentage of upper (p = 0.036) and lower (p = 0.017) meibomian gland area losses than the group without diabetic retinopathy (20 patients). According to multilinear regression analyses considering sex, age, and diabetes-related characteristics, the Schirmer's test value was significantly lower with increasing stage of diabetic retinopathy (β = −1.180, p = 0.016). The percentage of upper meibomian gland area loss was significantly increased with increasing age (β = 0.605, p < 0.001), glycosylated hemoglobin (β = 1.881, p = 0.011), and stage of diabetic retinopathy (β = 4.458, p = 0.001). The percentage of lower meibomian gland loss area was significantly increased with increasing age (β = 0.443, p = 0.001) and stage of diabetic retinopathy (β = 4.879, p = 0.001).

Conclusions

In patients with type 2 diabetes, the more severe the diabetic retinopathy, the more likely the meibomian gland loss will occur, so careful and appropriate treatment should be conducted.

Keywords: Diabetic retinopathy, Dry eye syndrome, Meibomian gland

Figures and Tables

Figure 1

Method of calculating total meibomian gland area and meibomian gland loss area using Image J® (NIH, Bethesda, MD, USA). Whitish area represents the meibomian gland. The ratio of meibomian gland loss area (%) = (meibomian gland loss area/total meibomian gland area) × 100. (A) Total meibomian gland area of the lower lid, (B) meibomian gland loss area of the lower eyelid in the same patient.

Table 1

Demographics and clinical features of study populations

Values are presented as mean ± standard deviation or number.

M:F = male:female; TBUT = tear break-up time; OSDI = ocular surface disease index; LLT = lipid layer thickness; MG = meibomian gland.

^*n = 71 (due to a missing data).

Table 2

The comparisons of patient characteristics according to DR existence

Values are presented as mean ± standard deviation or number unless otherwise indicated.

M:F = male:female; DR = diabetic retinopathy; TBUT = tear break-up time; OSDI = ocular surface disease index; LLT = lipid layer thickness; MG = meibomian gland.

^*Independent t-test; ^†chi-square test; ^‡n = 19 (due to a missing data).

Table 3

Multiple linear regression of age, sex, HbA1c, duration of diabetes, and DR grading on Schirmer's test, and percentage of upper and lower lid meibomian gland loss area

DR = diabetic retinopathy; MG = meibomian gland.

^*Multiple linear regression.

Notes

This study was presented as an e-poster at the 119th Annual Meeting of the Korean Ophthalmological Society 2018.

This study was presented as a poster at the Annual Meeting of the Association for Research in Vision and Ophthalmology 2018.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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