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Diabetes and Dry Eye: Issues, Symptoms, and Exams

(I-MED Pharma)

The TFOS DEWS II Report defines dry eye as a multifactorial disease of the ocular surface, explaining that it is “a significant and complex, functional disorder that cannot be characterized by a single process, sign or symptom.”[1]

Many risk factors can lead to the development or worsening of this ocular surface disorder, including certain behaviours or environments, hormonal changes or imbalances, low fatty acid intake in the diet, other diseases (for example Sjögren’s syndrome), or even psychiatric conditions.[1]

Awareness for how specific factors can impact the eyes is an important step in protecting and maintaining ocular health and comfort.

In this blog post we will look at one risk factor in particular for dry eye disease, diabetes,[1] which is a challenging and chronic metabolic disease characterized by elevated blood glucose levels. Although diabetes has been known since antiquity, the introduction of insulin in 1922 and oral hypoglycemic agents in the 1950s has transformed the outlook for diagnosed patients.[2] However, even today, this increasing health problem – considered a global epidemic[3] – has a high cost and burden to patients, their families, and society, not only from the illness itself, but also from associated chronic complications, including heart, kidney, and ocular disease and blindness.[2]

Let’s examine some of the effects diabetes can have on the eyes and look specifically at the link to dry eye.

What eye diseases are caused by diabetes?

In an article discussing ocular complications of diabetes, the authors write, “Even when well controlled, diabetes has a profound adverse effect on the ocular tissues, which parallels the severity of the disease and the stage at which it was diagnosed.”[3] From this statement, we understand that diabetes can have serious consequences for the eyes and that early diagnosis and management is critical for ocular health.

Some of the ocular complications associated with diabetes includes diabetic retinopathy, which is a progressive blinding disease that is a leading cause of blindness,[3] as well as increased risk for cataract formation.[2] Diabetes can also cause changes to the front of the eye and tear function, such as inflammation of the ocular surface and alterations in the lacrimal glands.[4]

Does diabetes cause dry eyes?

Dry eye is common in the diabetic population,[5] and there is growing research on its effects on the ocular surface, showing that significant changes to the front of the eye happens even early in the disease process.[6]

Patients with diabetes can have decreased tear lipid thickness, tear stability, corneal sensitivity, and tear quantity,[5] and increased Meibomian gland dysfunction and blepharitis, which results in increased rates of dry eye disease.[6]

Diabetes: Eye Symptoms

The symptoms for diabetic patients with dry eye disease can be similar as for dry eye patients without diabetes, and can include a gritty feeling in the eyes, sensitivity to light, itching, tearing, and pain in the eyes, and symptoms are typically severe in diabetic patients with poor glycemic control.[5]

Diabetes and eye exams: The important role of eye care professionals.

Regular visits to eye care professionals (ECPs) can be vital in early diagnosis and management of diabetes-associated ocular complications in prediabetic and diabetic patients, which allows ECPs to be more proactive in reducing the risk of serious ocular complications in their patients.[6] Examination for dry eye should be an important part of eye exams in patients with diabetes.[5]

Because ocular health can be adversely affected even in the early stages of this disease, it is important for those who are both prediabetic and diabetic to discuss eye symptoms and seek proper eye care.

Dry eye management and treatment for diabetic and nondiabetic dry eye patients are often similar, which includes the use of artificial tears.[5] Our dry eye clinic finder can help you find an eye care professional near you that carries I-MED Pharma’s dry eye products.


Prediabetes and diabetes are growing exponentially worldwide, and this challenging condition can have serious consequences for the eyes, adversely impacting ocular health even in the early stages of the disease. Regular visits to eye care professionals for a dry eye examination can help with the management and treatment of discomforting ocular symptoms.

While diabetes is only one of the many risk factors for dry eye disease, it’s important to recognize the specific risk factors that may affect the health of your eyes so you can take the proper steps to protect your overall ocular health.

[1] Craig, Jennifer P, J. Daniel Nelson, Dimitri T Azar, Carlos Belmonte, Anthony J Bron, Sunil K Chauhan, Cintia S de Paiva, et al. 2017. “TFOS DEWS II Report Executive Summary.” The Ocular Surface 15 (4): 802–12.

[2] Watkins, Peter J. 2003. “Diabetes and Its Management. 6th ed.” Blackwell Science.

[3] Vieira-Potter, Victoria J, Dimitrios Karamichos, and Darren J. Lee. 2016. “Ocular Complications of Diabetes and Therapeutic Approaches.” BioMed Research International.

[4] Garzon P Sandra Johanna, Antonio Lopez-Alemany, and Andres Gene-Sampedro. 2019. “Correlation Between Type 2 Diabetes, Dry Eye and Meibomian Glands dysfunction.” Journal of Optometry 12 (4): 256–.

[5] Zhang, Xinyuan, Lin Zhao, Shijing Deng, Xuguang Sun, and Ningli Wang. 2016. “Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics.” Journal of Ophthalmology 2016: 8201053–57.

[6] Richdale, Kathryn, Cecilia Chao, and Marc Hamilton. 2020. “Eye Care Providers’ Emerging Roles in Early Detection of Diabetes and Management of Diabetic Changes to the Ocular Surface: a Review.” BMJ Open Diabetes Research & Care 8 (1): e001094–.