Indian Journal of Clinical and Experimental Ophthalmology 2020;6(3):338–342

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Indian Journal of Clinical and Experimental Ophthalmology

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Original Research Article

Evaluation of ocular manifestations in Type 2 Diabetes mellitus

Deepa R1, *, Anuradha P1

1 Dept. of Ophthalmology, Saveetha Medical College, Chennai, Tamil Nadu, India

ARTICLE INFO ABSTRACT

Article history: Objective: The prevalence of diabetes mellitus is increasing globally and a range of ocular conditions with
Received 11-04-2020 sight threatening complications due to diabetes are known to occur. Aim of this study is to evaluate diabetes
Accepted 18-04-2020 related ocular changes in patients with type 2 diabetes mellitus in a tertiary care hospital.
Available online 30-09-2020 Design: Observational study.
Materials and Methods: Study was conducted with a total number of 90 patients with Type 2 diabetes
mellitus in a tertiary care hospital. Patients aged 40 to 70 years with duration of diabetes mellitus of more
Keywords:
than 5 years were included. They underwent a detailed fundus examination and ocular evaluation which
Diabetes mellitus included refraction, Schirmer’s test, corneal sensitivity, Applanation tonometry, gonioscopy along with
Diabetic eye diseases systemic investigations and the observed findings were recorded.
Diabetic retinopathy
Results: It was noted that among the study population, majority of them (42.2%) were in the age
Ocular manifestation
group between 51-60 years and men (54.4%) were more in number than females (45.5%). Diabetic
retinopathy was the most common ocular manifestation (47.7%) followed by cataract (44.4%), cranial
nerve palsy(16.6%) and glaucoma (16.6%).
Conclusion: These ocular findings suggest that regular screening and eye examinations of diabetic patients
is mandatory to reduce the burden of visual impairment.

© 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license
(https://creativecommons.org/licenses/by-nc/4.0/)

1. Introduction diseases involving structures from the lids to retina and to

cranialnerves. 3–5 Current treatment modalities are aiming to
The prevalence of diabetes mellitus (DM) is increasing preserve vision and to prevent blindness by timely diagnosis
globally in both developed and developing countries. 1 The and treatment of ocular manifestations due to diabetes. 6 The
global prevalence of diabetes mellitus in the year 2017 was aim of this study is to evaluate the diabetes related ocular
estimated to be approximately 425 million and it is said to changes in patients with type 2 diabetes mellitus in a tertiary
increase to approximately 630 million in 2045. 2 care hospital.
Type 2 Diabetes mellitus, which is a disease of
impaired metabolism characterized by insulin resistance 2. Materials and Methods
and relative decrease in insulin secretion. Chronic state of
hyperglycemia of diabetes, is associated with damage to A hospital based Observational study which included 90
blood vessels, eyes, kidneys, nerves and heart. There is patients who attended the OPD of our tertiary care hospital
a high potential for vision loss in patients with diabetes over a period of 9 months from January 2019 to September
mellitus, with approximately two-thirds of the population 2019 and the study was approved from the Institutional
having varying degrees of visual impairement after 30 – Ethical committee. Patients aged 40 to 70 years with
40 years of diabetes, manifesting with a range of ocular type 2 diabetes mellitus, of duration of more than 5
years were included in the study. Patients with associated
* Corresponding author. systemic co-morbidities, previous treatment in the eye or
E-mail address: deepamoorthy16@gmail.com (Deepa R). ocular trauma were excluded from the study. A detailed

https://doi.org/10.18231/j.ijceo.2020.073
2395-1443/© 2020 Innovative Publication, All rights reserved. 338
 Deepa R and Anuradha P / Indian Journal of Clinical and Experimental Ophthalmology 2020;6(3):338–342 339

history was obtained along with systemic examination Table 1: Distribution of study population based on BCVA
was done. All patients were subjected to routine systemic BCVA Number of patients (n=90)
investigations. Ocular examination and evaluation was done 6/6-6/18 20(22.2%)
which included best corrected visual acuity, Schirmer’s test, 6/18-6/60 26(28.8%)
corneal sensitivity, Applanation tonometry, gonioscopy and 6/60-3/60 28(31.1%)
fundus examination using IDO and the observed findings < 3/60 16(17.7%)
were recorded.

3. Results Based on the various corneal findings observed in

13 patients of the study population, 2(15.3%) patients
Among the study population of 90 patients, there were had exposure keratopathy, 7 (53.8%) patients had corneal
31 patients (34.4%) in the age group of 40-50 years, 38 ulcer, 4(30.7%) patients had superficial punctuate keratitis.
patients (42.2%) of age group between 51-60 years and 21 Incidence of dry eye among the diabetic patients was 25.5%.
(223.3%) patients aged 61-70 years. (Figure 1) and there Association of various types of glaucoma in the diabetic
were 49 males (54.4%) and 41 females (45.5%). (Figure 2). patients are shown in the Table 2. Diabetic retinopathy was
Distribution of study population based on best corrected present in 43 patients (47.7%) and it was graded according
visual acuity is depicted in Table 1, among which 16 patients to ETDRS classification as in Table 3.
(17.7%) had BCVA < 3/60. Ocular manifestations of
patients with type 2 diabetes is shown in Figure 3, of which Table 2: Type of glaucoma among the diabetic patients
Diabetic retinopathy is the most common manifestation seen Type of Glaucoma Number of patients ( n=15)
in 43 patients (47.7%) followed by Cataract in 40 patients POAG 7(46.7%)
(44.4%). PACG 2(13.3%)
NVG 5(33.3%)
Lens induced glaucoma 1(6.66%)

Table 3: Classification of Diabetic retinopathy among the study

population
Grades of DR Number of patients (n=43)
Mild NPDR 9(20.9%)
Moderate NPDR 12(27.9%)
Severe NPDR 16(37.2%)
Fig. 1: Age distribution High risk PDR 3 (6.97%)
Advanced PDR 3 (6.97%)
DME 21 (48.83%)

4. Discussion
Thus this study help us to know the different spectrum
of ocular manifestation of patients with Type 2 diabetes
mellitus In our study, majority of them were in the age
group 51-60 years (42.2%) as in accordance to many
studies. 7–9 and males were more in number than females
but a study reported that chronic subclinical inflammation
showed stronger association of Type 2 DM with women
than men. 10 According to our study, majority of the patients
(31.1%) with best corrected visual acuity was between 6/60-
3/60 and around 17.7% had visual acuity <3/60 which
Fig. 2: Sex distribution emphasizes that all diabetic patients must be aware of the
vision threatening complications of diabetes and hence the
Among the diabetic patients who presented with cranial need for regular eye examinations. 11,12 It was noted in our
nerve palsy (16.6%), the pattern of involvement of cranial study that most common acquired cranial nerve palsy due to
nerve palsy is as follows (n=15).(Figure 4) diabetes(16.6%) was abducens nerve followed sequentially
340 Deepa R and Anuradha P / Indian Journal of Clinical and Experimental Ophthalmology 2020;6(3):338–342

Fig. 3: Distribution of study population based on ocular manifestations

by oculomotor nerve, facial nerve and trochlear nerve. As patients detected with glaucoma(16.6%), the most common
reported, diabetes is the underlying cause in 25-30% of was primary open angle glaucoma followed by neovascular
the patients aged above 45 years who developed acute glaucoma. About 44.4% of the study group manifested
extraocular muscle palsy. 13 Corneal abnormalties were with cataract and numerous studies have documented an
noted in 14.4% of the patients while a study reported that association between diabetes and cataract. 19–22 Diabetic
corneal pathologies were detected upto 73.6% of patients retinopathy being the major cause of visual impairment in
with diabetes due to high accumulation of sorbitol. 14 patients with diabetes, 23–28 about 47.7% of patients have
Patients with diabetes are at a risk of developing two major been diagnosed with diabetic retinopathy where majority
types of glaucoma which is primary open angle glaucoma of them had severe NPDR. Thus this study revealed a
and neovascular glaucoma 15–18 as in our study among the wide spectrum of ocular conditions that has been associated
 Deepa R and Anuradha P / Indian Journal of Clinical and Experimental Ophthalmology 2020;6(3):338–342 341

Fig. 4: Pattern of involvement of cranial nerve palsy

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