Dry Eye Syndrome: Who’s Most at Risk and What Does Diabetes Have to Do With It?

Burning. Nuisance in the light with the sensation of having the classic grain of dust inside the eye. Tirednessespecially when reading a book or spending a long time in front of a computer screen or being constantly connected via smartphone. In short, also due to the high level of environmental pollution, the dry eye syndrome is lurking.

Studies say that More than one in ten people suffer from it and that it is mostly women who have to deal with this condition. But given the spread of classic “calls” and video appointments with colleagues who often meet especially in smart working, the solicitation for the eye tends to increase also in the male population. Not only that. This condition is often associated with diabetes.. And it is precisely in this sense that an information campaign entitled “If you have diabetes, open your eyes to dry eyes”.

But why does the eye become dry? And what can be done to prevent this condition, dealing with it in the best way? Here are some useful tips to know how to behave.

How important are tears

Dry eye is related to an alteration of the protective tear film, with potential damage to the ocular surface. Tears have great importance in the health of the organ of vision. First of all, they help keep the eye lubricated: the eyelids protect the ocular surface from the external environment thanks to the blinking made possible by the presence of the tear film that lubricates the surface itself. The eyelid blink determines a continuous distribution of tears to keep the external surface of the eye in optimal conditions for the visual process. Furthermore, tears provide nutrients to the cornea (the transparent front part of the eyeball) which is devoid of blood vessels, on the one hand, and on the other hand, they protect the eye by washing and removing waste substances and preventing germs from proliferating and taking root.
Let’s pay attention to tears then. And not only in terms of quality but also in terms of quantity. The tear fluid it is extremely fast in completely covering the surface of the eyeball, with a speed that even exceeds that of blinking which appears extremely fast to us. This speed of action is fundamental and is of great use for the eyeball. For this reason, when the function of tears is poorly effective, problems can arise.

How the tear film changes in dry eye

The alteration of the tear film responsible for a “dry eye” can be of a quantitative nature, when the liquid component is missing, or also of a qualitative nature, if instead the formula of the tear film is modified. “perfect” tear which must have three components: aqueous, fatty and mucous. It should also be noted that at the origin of the problems There may also be abnormalities of the eyelids and blinking mechanism, prolonged use of contact lenses and other problems.
Among the enemies main causes of tears, in addition to drugs, there is certainly air pollution. To understand the reasons for this relationship, it is important to remember that tears are made up of two fundamental layers, even if they appear uniform. The first is predominantly lipidic in nature, that is, it is made of fats and is the actual barrier to the outside world. It also slows down the evaporation of the innermost layer. Under this lipidic layer, in direct contact with the eye, there is the more liquid portion of the tear film that can be defined as mucoaqueous: it has various tasks, such as ensuring the passage of nutrients to the eye and above all it allows the tear to remain “adhesive” to the eyeball.
The alteration of the tear film responsible for a “dry eye” can therefore be quantitative type due to a deficit of the aqueous component (hypolacrimia) or qualitative type (dyslacrimia) due to alterations in one of the three components (aqueous, lipid, mucosal) and due to mechanical alterations (abnormalities of the eyelids, blinking, ocular surface, contact lenses, hypoesthesia).

What factors can facilitate the onset of dry eye?

Environmental pollution, both indoor and outdoor, is one of the elements that most commonly increases the risk of developing dry eyes. It is clear that such a complex structure with such important tasks is influenced by environmental components. For example, air pollution, which is generically called smogis composed mainly of fat molecules. Chemistry says that by putting two lipid structures in contact, one tends to progressively “consume” the other. For this reason Air pollution tends to alter the structure of the tear film promoting its evaporation. But that’s not all. Even the atmospheric events which tend to attack the lipid component of tears, such as wind, very dry and arid air or air conditioning: all these environmental changes can favor the evaporation of the tear film and therefore “dry” the eye.
The dangers are therefore mainly linked to smog and cigarette smoke.which facilitate the modification of the structure of tears by influencing their fatty component.
Also the abuse of air conditioning can still be important. The reason? It can induce an excessive reduction in environmental humidity which affects the amount of available tear fluid. The same also happens in case of dry weather.
Finally, it should not be forgotten the role of the PC and prolonged use of screens. The reduction in blinking associated with prolonged presence in front of a computer screen can facilitate the evaporation of tear fluid and therefore also the onset of dry eye symptoms.

What is the relationship between dry eye and diabetes?

As Antonio Di Zazzo, Associate Professor of Visual Diseases at the Fondazione Policlinico Universitario Campus Bio-Medico in Rome, recently explained, Diabetes is a specific risk factor for dry eye. And this is exactly the message that the campaign is carrying forward.If you have diabetes, open your eyes to dry eyes“.

“In a study conducted by me, it was highlighted that approximately 70% of patients have ocular discomfort and that ocular discomfort, which includes dry eye, increases with the increase in glycemic imbalance and the number of years of disease – comments the expert. This happens because there is damage affecting peripheral nerve fiberscalled diabetic corneal neuropathy, which leads to the release of neuromediators, i.e. inflammatory mediators, and which produces a chronic inflammation of the ocular surface, called persistent neurogenic inflammation”.

The advice for those who suffer from diabetes, but in general for all people who suffer from dry eyes, is therefore to don’t underestimate the problem.
“If the diabetic patient detects ocular discomfort, he should not underestimate it, because it represents a marker of neuropathic damage – Di Zazzo reiterates. It is therefore essential to go to the ophthalmologist for further investigation. The specialist uses a diagnostic machine called confocal microscopycan see the nerves in vivo in a non-invasive way. Through this investigation, the ophthalmologist performs an analysis of the nerve fibers to detect the presence of diabetic neuropathy, which causes discomfort at the ocular level, but which can also be predictive of other systemic pathologies such as, for example, diabetic foot, heart problems, alterations of metabolism”.

Advice for targeted treatments? “Certainly in the case of diabetic patients it is important recover glycemic imbalancebecause it affects the performance of the nerves, then you need to intervene with eye drops based on hyaluronic acid or hydroxypropylguar or carboxymethylcellulose, which act where the aqueous component is missing, restoring the structure of the tear film – concludes the expert. Finally, there are some eye drops which act on the nerve fibres, stimulating and regenerating them precisely where the damage is present”.

What to do if you suffer from dry eye

Generally speaking, it is said that the treatment must always be prescribed by an ophthalmologist specialistit is essential to always keep the ocular surface lubricated, using artificial tears.
On the environmental front it is convenient limit the use of air conditioningtrying to change the environment for a few minutes at least every two hours.
On sunny and windy days you have to use glasses that protect the eye also laterally. And above all, it is important not to overdo the use of contact lenses, especially in the presence of reduced tear production.
In short: on the treatment front, in most cases it is necessary instill tear substitutes to lubricate the eyeThere are many of them, often different from each other, and the choice must be made by the ophthalmologist.
But be careful: sometimes dry eye can be linked to autoimmune diseases, inflammation of the eyelids or the results of alterations of the conjunctiva. In these circumstances, the treatment must obviously be targeted on a case-by-case basis.