I am sure you have been told that diabetes increases the risk of eye disease often resulting from elevated blood glucose levels over extended periods of time. The disease most commonly discussed in the literature is that of “diabetic retinopathy”. This eye disease occurs when the blood vessels are damaged in the light-sensitive tissue of the back of the eye (retina). Many people experience no symptoms or mild vision loss initially but if not treated, it could lead to blindness. Both type 1 and type 2 patients can develop this eye complication. Regular screening is important for early detection. If diagnosed in the early stages, treatment is available. For more information I refer you to this reference from the Diabetes Canada guidelines.
However, there are other eye complications that you may not be aware of and this is what I will concentrate on in today’s discussion. I was diagnosed with this eye disease a few months ago.
Keep in mind that eye disease can be experienced by anyone with or without diabetes, just those of us with diabetes are at a higher risk.
Dry eye disease (DED) or Dry eye Syndrome (DES):
Dry eye is an inflammatory process that is chronic and progressive and results in loss of the eyes being able to produce tears properly, a deficiency of the lacrimal gland. As well, the consistency of the tear may be altered. The Meibomian gland, the part of the eye that is responsible for slowly releasing the oil into your tear film, becomes dysfunctional and thus the tear lacks the oil and evaporates quickly. If this happens you can start to have blurred vision and eye discomfort. If we lack tears, then the moisture on the surface of our eye is gone and clear vision declines. Inflammation on the surface of the eye occurs and if not treated, pain, scars and loss of some vision can occur. On a personal note this is what I experienced this summer.
My experience with DES was very similar to what I described above. I noticed by vision changing but if I put on my glasses, which were new at the time, the problem seemed to be resolved. I even went back to get my glasses checked to be sure they were made with the correct vision requirements as noted at the time of eye testing. I started to use lubricant eye drops four times a day and never thought too much about it. I had read somewhere that wearing masks could contribute to dry eyes and since I was wearing masks all day long, I contributed the dry eyes to mask wearing. So what made me pay more attention?
Well, it was when my eyes became very sensitive to light, a problem known as photophobia. At the same time, I came across an article discussing dry eyes and when I saw the warning that if my eyes were light sensitive, I needed to see an eye care practitioner.
The causes of dry eye and predisposing factors are multiple such as:
1. Age-the older we are, the drier the eyes can get.
2. Gender-women are more prone to it than men because of women’s hormonal changes.
3. Medications- blood pressure medication, birth control pills, antihistamines (which I had to stop), and drugs to treat depression (antidepressants) can reduce tear production. Ask you pharmacist if any medications you are taking could contribute to the dry eye syndrome.
4. Medical conditions other than diabetes include rheumatoid arthritis, lupus and thyroid problems, other eye diseases.
5. Environmental factors-such as dry and windy climates or low humidity.
6. Miscellaneous causes such as ethnicity, menopause, smoking, vision corrective surgery.
7. Prolonged screen time or staring at a computer screen for long periods.
8. Decreased blink time that may occur during activities such as reading and watching television.
Symptoms of dry eye disease include:
· Blurred vision, light sensitivity, scratchy or gritty feeling in the eye. I had all of these symptoms as time passed.
· Other symptoms such as red eyes, a burning sensation or excessive tearing did not happen to me.
· Red flag symptoms that need attention by the eye care practitioner are pain, light-sensitivity, vision disturbances or any blunt trauma or chemical exposure to the eye.
Management of dry eye disease/syndrome:
o Maintain blood glucose levels and blood pressure in acceptable ranges.
o Make an appointment with the eye care practitioner as soon as symptoms become evident. Don’t do like I did and leave it a long time.
o Eliminate any modifiable risk factors such as: avoid antihistamine use if at all possible after discussing with your health care team, stop drugs that have drying effects if possible, stop smoking, add moisture to the air by using humidifiers, decrease screen time, wear sunglasses, increase fluid intake.
o Use warm compresses and eyelid massage to manage irritative symptoms. I do this twice a day. The eyepad mask is heated for 20-25 second and then applied for 10 minutes. The heat unblocks the the meibromian gland dysfunction. Your vision will be blurry for a few minutes afterwards.
o Use lubricant eye drops at least 4 times a day. Use a product that is preservative-free to avoid any negative effects produced by the preservative. This type of eye drop is meant to replace and or supplement the natural tear film but it does NOT target the underlying cause. Ask your pharmacist to recommend a product that is free of preservatives. You do not need a prescription to buy this type of product.
o Pharmacological therapy will include eye drops that contain a topical corticosteroid. This can be used for up to 2-4 weeks with a tapering downward frequency as use continues. This will help to relieve the eye inflammation. You would need a prescription for this type of eye drop.
o Two newer products have been approved by Health Canada and the FDA in the past several years. One product has the active ingredient lifitegrast . This product is believed to decrease inflammation and increase tear production by blocking a protein called LFA-1 from interacting with another protein called ICAM-1 in the eyes It comes as a 5% topical solution and used twice a day. The second product contains the ingredient cyclosporine which also works by regulating inflammatory processes in the eye that can affect tear production. It is prescribed for twice a day use also. Both of these products are meant for long term treatment.
o Always remember to wash your hands before using any type of eye drop. This link describes how to instill eye drops properly and it provides some good tips which I hope you might be able to put into practice.
The Diabetes Canada guidelines for initiating eye screening are:
Type 1 diabetes: 5 years after diagnosis in all individuals greater than or equal to 15 years
Type 2 diabetes: at time of diagnosis regardless of age. Keep in mind that since type 2 may have existed a while before the diagnosis, eye damage could have started.
Don’t hesitate to call for an appointment with your eye care specialists at any change to your vision.
As for my recovery, my vision has improved but I still have trouble with small print that even my glasses don’t always resolve. However, I was advised that this healing can take some time so I will visit the optometrist in the spring and get a full evaluation of my eye status.
I hope you have enjoyed the information provided on Dry Eye Disease/Syndrome. It is a problem that we hear little about, yet my readings tell me it is a fairly common problem in the general population.
Thank you for your time. Please make any comments and forward any topics/ideas would you like to have reviewed in future blogs.
Thank you all for your kind words & wishes on my retirement in the blog of October 30th,2021.
This information does not replace that of your health-care team. It is meant for information purposes only. November is diabetes awareness month. This year is the 100th anniversary since the discovery of insulin in Canada. Check for celebrations that are taking place in Canada or the country you reside. Insulin was a huge discovery and changed the lives of millions of people.
References:
PharmacyPractice and Business, OTC Counselling Tips; June/July 2021 Vol.8.No.4
Diabetes Canada Guidelines accessed on-line November 10th,2021
National Institute of Diabetes and Digestive and Kidney Disease ; Diabetic Eye Disease
PS: Whether you have diabetes or not, this website is very informative.
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