COMPARATIVE ANALYSIS OF DRY EYE SYNDROME AMONG DIABETIC VERSUS NON-DIABETIC PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL, PESHAWAR. A CASE-CONTROL STUDY.
Main Article Content
Abstract
Background: Dry eye syndrome (DES) is a multifactorial ocular surface disorder that is becoming increasingly prevalent with advancing age and rising rates of diabetes mellitus worldwide. Among diabetic individuals, ocular surface abnormalities such as tear film instability and epithelial damage are frequent yet often underdiagnosed complications. The geriatric demographic, especially those with comorbidities, are at a significantly higher risk for DES due to systemic changes and impaired lacrimal gland function.
Objective: To compare the prevalence of dry eye syndrome between diabetic and nondiabetic patients attending the ophthalmology outpatient department at a tertiary care hospital in Peshawar.
Methods: This case-control study was conducted at the Eye OPD of Lady Reading Hospital, Peshawar, from October 5, 2020, to December 5, 2023. A total of 100 participants were selected using convenience sampling and divided equally into two groups: 50 diabetic patients (cases) and 50 nondiabetic individuals (controls), all above 40 years of age. A comprehensive anterior segment examination was performed using slit lamp biomicroscopy. Dry eye diagnosis was established through two diagnostic tools: the Schirmer test (values <10 mm considered dry; <5 mm considered severely dry) and fluorescein staining (presence of more than three stained cells indicating surface damage). Data were processed using SPSS version 25 and EPI Info 16, with significance assessed via chi-square analysis.
Results: Among diabetic patients, 12 out of 50 (24%) were diagnosed with DES, compared to 26 out of 50 (52%) in the nondiabetic group. The calculated odds ratio was 7.90 at a 95% confidence interval, with a statistically significant p-value of 0.004943 (p < 0.05), indicating a notable association between diabetes and DES.
Conclusion: The study indicates a significant association between diabetes mellitus and the development of dry eye syndrome, emphasizing the need for early ocular screening in diabetic patients for timely intervention.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Albdaya, N. A., Binyousef, F. H., Alrashid, M. H., Alajlan, A. A., Alsharif, F. A., Alfouzan, S. K., & Alhuthail, R. R. (2022). Prevalence of Dry Eye Disease and Its Association With the Frequent Usage of Eye Cosmetics Among Women. Cureus, 14(7), e27142.
Calli, U., Ozturk, Y., & Demir, G. (2022). The Effect of Fluorosecein on Corneal Endothelial Structure and Morphology in Diabetic Retinopathy Patients undergone Fundus Fluoresecein Angiography. Beyoglu Eye J, 7(1), 35-38.
Huang, R., Su, C., Fang, L., Lu, J., Chen, J., & Ding, Y. (2022). Dry eye syndrome: comprehensive etiologies and recent clinical trials. Int Ophthalmol, 42(10), 3253-3272.
Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health, 10(1), 107-111.
Pan, L. Y., Kuo, Y. K., Chen, T. H., & Sun, C. C. (2022). Dry eye disease in patients with type II diabetes mellitus: A retrospective, population-based cohort study in Taiwan. Front Med (Lausanne), 9, 980714.
Papas, E. B. (2021). The global prevalence of dry eye disease: A Bayesian view. Ophthalmic Physiol Opt, 41(6), 1254-1266.
Qian, L., & Wei, W. (2022). Identified risk factors for dry eye syndrome: A systematic review and meta-analysis. PLOS ONE, 17(8), e0271267.
Schaumberg, D. A., Sullivan, D. A., & Dana, M. R. (2002). Epidemiology of dry eye syndrome. Lacrimal Gland, Tear Film, and Dry Eye Syndromes 3: Basic Science and Clinical Relevance Part A and B, 989-998.
Tashbayev, B., Chen, X., & Utheim, T. P. (2024). Chalazion Treatment: A Concise Review of Clinical Trials. Curr Eye Res, 49(2), 109-118.
Zhang, X., Wang, L., Zheng, Y., Deng, L., & Huang, X. (2020). Prevalence of dry eye disease in elderly individuals: A protocol of systematic review and meta-analysis. Medicine (Baltimore), 99(37), e22234.
Zou, X., Wang, S., Zhang, P., Lu, L., & Zou, H. (2020). Quantitative Proteomics and Weighted Correlation Network Analysis of Tear Samples in Adults and Children With Diabetes and Dry Eye. Transl Vis Sci Technol, 9(13), 8.
Dai S, Long J, Han W, Zhang L, Chen B. Alleviative effect of probiotics and prebiotics on dry eye in type 2 diabetic mice through the gut-eye axis. Ocul Surf. 2025;36:244-60.
Ogawa K, Urata K, Maeda S, Ohno Y, Satoh K, Yamada Y, et al. Blueberry Leaf Extract Prevents Lacrimal Hyposecretion in Sjögren's Syndrome-like Model of Non-obese Diabetic Mice. In Vivo. 2023;37(1):149-62.
Ogawa K, Ohno Y, Tagashira A, Urata K, Satoh K, Fujimoto N, et al. Blueberry Stem Extract Prevents Lacrimal Hyposecretion in Non-obese Diabetic Mice via Activation of AMPK. In Vivo. 2023;37(3):1003-15.
Sun Y, Zhang Y, Shi F, Li Y, Wang C, Yu F, et al. Characterization and Role of Glucagon-Like Peptide 1 Receptor in the Lacrimal Gland: Novel Insights into Diabetic Dry Eye Pathogenesis. Am J Pathol. 2025;195(4):797-810.
Fu Z, Wan M, Jin T, Lai S, Li X, Sun X, et al. Electroacupuncture modulates the TLR4-NF-κB inflammatory signaling pathway to attenuate ocular surface inflammation in dry eyes of type 2 diabetic rats. Cell Mol Biol (Noisy-le-grand). 2024;70(5):111-8.
Zhang S, Wang Q, Qu M, Chen Q, Bai X, Zhang Z, et al. Hyperglycemia Induces Tear Reduction and Dry Eye in Diabetic Mice through the Norepinephrine-α(1) Adrenergic Receptor-Mitochondrial Impairment Axis of Lacrimal Gland. Am J Pathol. 2023;193(7):913-26.
Qu M, Wan L, Dong M, Wang Y, Xie L, Zhou Q. Hyperglycemia-induced severe mitochondrial bioenergetic deficit of lacrimal gland contributes to the early onset of dry eye in diabetic mice. Free Radic Biol Med. 2021;166:313-23.
Pei X, Ba M, Yang T, Xuan S, Huang D, Qi D, et al. Leptin Receptor Deficiency-Associated Diabetes Disrupts Lacrimal Gland Circadian Rhythms and Contributes to Dry Eye Syndrome. Invest Ophthalmol Vis Sci. 2025;66(1):19.
Schicht M, Farger J, Wedel S, Sisignano M, Scholich K, Geisslinger G, et al. Ocular surface changes in mice with streptozotocin-induced diabetes and diabetic polyneuropathy. Ocul Surf. 2024;31:43-55.
Chen S, Barnstable CJ, Zhang X, Li X, Zhao S, Tombran-Tink J. A PEDF peptide mimetic effectively relieves dry eye in a diabetic murine model by restoring corneal nerve, barrier, and lacrimal gland function. Ocul Surf. 2024;32:1-12.
Hwang JS, Shin YJ. Role of Choline in Ocular Diseases. Int J Mol Sci. 2021;22(9).
Dogru M, Kojima T, Simsek C, Nagata T, Tsubota K. Salivary and Lacrimal Gland Alterations of the Epidermal Fatty Acid-Binding Protein (E-FABP) in Non-Obese Diabetic Mice. Int J Mol Sci. 2022;23(7).
Debreceni IL, Chimenti MS, Serreze DV, Geurts AM, Chen YG, Lieberman SM. Toll-Like Receptor 7 Is Required for Lacrimal Gland Autoimmunity and Type 1 Diabetes Development in Male Nonobese Diabetic Mice. Int J Mol Sci. 2020;21(24).
Diaz D, Sassani JP, Zagon IS, McLaughlin PJ. Topical naltrexone increases aquaporin 5 production in the lacrimal gland and restores tear production in diabetic rats. Exp Biol Med (Maywood). 2024;249:10175.