Dry Eye Syndrome and Diabetes

Founding Father Benjamin Franklin’s famous quote, “An ounce of prevention is worth a pound of cure,” still rings true 250 years later. The wise inventor’s idiom suggests preventing a condition or illness is easier than fixing it after it has started. This resonates with several difficulties associated with type 1 diabetes.

Keeping blood glucose levels in normal range is critical to good diabetes management. It also wards off other health disorders tied with the disease. Namely, one of the more significant complications of type 1 diabetes patients is eye problems (retinopathy).

Dry Eye Health and T1D

When blood sugar (glucose) levels run high, it becomes harder for the eyes to produce enough tears, which leads to chronic dry eyes. Dry eye syndrome (DES) is a condition that can occur in T1D individuals. High blood sugar levels left unchecked, can damage the nerves that support healthy eye function and produce swelling in the macula (diabetes macular edema). This dangerous condition can destroy sharp vision and, without proper care, lead to blindness—raising the bar of severity in the list of ailments.

The first step with any issue is seeing your doctor to determine which course of action is needed. Once you undergo a treatment plan that includes controlling your blood sugar levels, you’ll immediately get relief from this pesky condition.

Dry Eye Causes, Symptoms and Treatments

According to a study by the American Diabetes Association, over 54% of people with diabetes have dry eye syndrome.

Dry Eye Causes

Since eye conditions affect over half of the diabetes population, you may be wondering why is it rarely discussed? DES, also called keratoconjunctivitis sicca, is a serious condition caused by a lack of fluid on and around the eye surface. 

Chronic high blood sugar levels increase the risk of DES and contribute to other eye problems. And with more than a dozen different types of dry eye—each may require varied treatment approaches.

Healthy eyes must remain moist, requiring constant tears of water, oil and mucus. Diabetes affects the gland that produces the watery part of your tears as well as the oil glands in the eye.

Dry Eye Syndrome’s Link to Gland Dysfunction 

When high blood sugar levels damage the nervous system, one consequence of this impairment is a breakdown of the lacrimal and meibomian glands, which play roles in tears’ production and lubricating abilities. 

Meibomian Gland Function

A 2019 meta-analysis concluded the associated risk of diabetes and dry eyes, and as DES is a common eye disorder of tear production, it’s important to understand how it works. The meibomian glands line the upper and lower eyelids and secrete oil, which coats the eyes' surface and keeps tears from evaporating. The Journal of Endocrine Society conducted a 2020 study that showed a link between high blood sugar and the meibomian glands' function.

Lacrimal Gland Function

The same study applies to eye health and decreased tear production associated with the lacrimal glands. These tear-producing glands are located in the upper outer portion of each eye and release fluid to protect the eyes’ surface. According to the ADA, insulin plays a critical role in the lacrimal glands’ function, and without enough insulin to support this, the body has limited tear production, resulting in inflammation and further eye damage. 

Other Dry Eye Syndrome Risk Factors:  

The American Academy of Ophthalmology cites other leading causes of dry eye syndrome:

• High blood glucose
• Too much computer screen time
• Contact lenses
• Hormonal changes
• A dry climate or a smoky, windy environment
• Beta-blockers and medications for high blood pressure, allergies, cold medicines, anxiety, depression, heartburn, and sleep disorders
• Secondary chronic conditions like lupus, rheumatoid arthritis, Graves’ disease, and thyroid disease
• Blepharitis – swollen red eyelids
• Entropion (eyelids turn in) and ectropion (eyelids turn outward)
• Eye surgery like LASIK

Dry Eye Symptoms

Dry Eye Syndrome can often feel like an irritation that can be ignored; however, it should be addressed before the problems escalate. The best approach is to visit an optometrist or ophthalmologist for a thorough check-up and testing.

Dry eyes can feel like the following:

• Stinging or burning
• Sensitivity to light
• Blurry vision
• Crusty mucus buildup
• Redness or irritation
• Pain with contact lenses
• Difficulty reading or a sensation something is in your eye.
• Difficulty driving at night.
• The overproduction of tears to compensate for dryness.

‍Dry Eye Treatments

How one treats DES varies mainly on the seriousness of the diagnosis. As your physician’s treatment brings relief, you may feel more comfortable and want to avoid future issues. Equally important is the lifestyle changes to prevent further complications. Similarly, your doctor must know all your medications to consider the best treatment.

Hopefully, through good diabetes management, your problems will correct themselves. If this is not the case, besides working with your healthcare team to keep your blood glucose levels in good range, here are some additional measures to control dry eye side effects and symptoms.

Artificial tears or eye drop medications that increase tear production may relieve some DES issues. Other ways to provide additional moisture might include having your tear ducts blocked with silicone plugs or closed to keep your tears in your eyes for more extended periods. Other treatments are simple in-patient procedures or anti-inflammatory eye drop medications to get the oil glands flowing.

Interesting Fact: You may have blurry vision when you start insulin treatment due to excessive fluids. However, this should be corrected within a few weeks.

Dry Eye Disease and Retinopathy

While stressing the causes and treatment of DES, it’s important to note that diabetic retinopathy is associated with dry eye disease, and diabetic retinopathy has no symptoms until the damage is severe. The damage to your retina can occur before it affects your vision.

The increased chances of retinopathy result from poorly controlled glucose, high blood pressure, high cholesterol, and smoking.

Other diabetes Eye Problems:

Cataract - Cloudiness of the eye lens

Glaucoma – Increased pressure in the eye

Macular edema – Blurry vision due to fluid leaking into the area of the retina

Retinal detachment – Scarring may cause part of the retina to pull away from the back of the eyeball.

Keeping Good Range Improves Vision

Scare tactics and other means of intimidation rarely achieve the intended goals. Studies have shown they aren’t effective in preventing drug and alcohol abuse in teens, nor are they useful to young adults facing the rigors of type 1 diabetes.

Like everything in life, we have choices, which can be hard or easy lessons. Instead of focusing on the potential adverse outcomes of less desirable glucose readings - switch your focus to what you can and are doing right, like reading this article for one! Use your logic, draw conclusions, and do your best. Preventative diabetes science and technology are growing leaps and bounds, making T1D life easier. Education equals power, and a powerful mind leans toward a powerful body—and an overall powerful you.