Peripheral neuropathy associated with dry eye disease in patients with diabetes
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Key takeaways:
- The odds of developing dry eye disease were nearly four-times higher in patients with moderate to severe peripheral neuropathy.
- Dry Eye Questionnaire-5 scores were significantly higher among these patients.
Patients with type 2 diabetes and more severe peripheral neuropathy appeared to be at greater risk for developing dry eye disease, according to a study published in Optometry and Vision Science.
“Previous studies have reported conflicting results on the association between dry eye disease and diabetic peripheral neuropathy,” Shyam Sunder Tummanapalli, PhD, a postdoctoral research scientist at the University of New South Wales School of Optometry & Vision Science, and colleagues wrote. “This apparent variability is attributed to the lack of standardized diagnostic criteria for dry eye disease, differing methodologies assessing peripheral neuropathy and relatively low statistical power. Moreover, these studies have not accounted for physiological or pathological influential covariates of both dry eye disease and peripheral neuropathy.”
To investigate the association between dry eye disease and severity of peripheral neuropathy, the researchers conducted a prospective, cross-sectional study of 63 patients with type 2 diabetes. Participants were assessed for dry eye disease via Ocular Surface Disease Index questionnaire and Dry Eye Questionnaire-5 (DEQ-5), tear osmolarity, lipid layer thickness, noninvasive keratographic tear breakup time, phenol red thread test and ocular staining.
According to results, 76% of participants had no or mild peripheral neuropathy and 24% of participants had moderate to severe peripheral neuropathy. A total of 50% of participants were diagnosed with dry eye disease, although 33% did not experience symptoms.
Among those in the moderate to severe neuropathy group, the odds of developing dry eye disease were 3.8-times higher vs. the no or mild neuropathy group (P = .03).
In addition, the researchers reported that mean DEQ-5 scores were significantly higher in the moderate to severe group, whereas mean phenol red thread test values and corneal nerve fiber length were significantly reduced.
After controlling for confounding factors, including age, gender, HbA1C and duration of diabetes, they also reported that neuropathy scores were independently associated with phenol red thread test values and corneal nerve fiber length.
“The lack of correlation between dry eye disease symptom severity and corneal nerve loss indicates that these patients are often asymptomatic, which may be due to compromised corneal sensitivity,” Tummanapalli and colleagues wrote. “It is therefore imperative to evaluate the ocular surface in patients with diabetes, irrespective of symptomatology.”
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