The prevalence and associated factors of dry eye disease amongst people diagnosed with diabetes mellitus in Bronkhorstspruit.

Abstract

Background: Dry eye disease (DED) is a common ocular surface disorder with a significant impact on quality of life. Its prevalence is higher among individuals with diabetes mellitus (DM), yet limited evidence exists in African settings, particularly in rural communities. Hence, the present study aimed to determine the prevalence and associated factors of DED among individuals living with diabetes in Bronkhorstspruit, South Africa.

Methods: A cross-sectional study was conducted between November 2024 and February 2025 among 236 diabetic patients selected through simple random sampling from a public hospital and a private clinic. Standardized diagnostic tests (tear break-up time [TBUT], Schirmer test) and the Ocular Surface Disease Index (OSDI) questionnaire were used to diagnose and grade DED. Socio-demographic and ocular history data were collected. Logistic regression was performed to identify determinants of DED, with results reported as odds ratios (ORs) at 95% confidence intervals (CIs).

Results: Of the 163 participants analyzed, the prevalence of DED was 81.6%. Prevalence increased with age, with the ≥65 years group most affected (Males: 50.0%; Females: 38.4%). Participants aged ≥45 years were 4.5-9.1 times more likely to develop DED compared to those aged ≤44 years. Females reported higher rates of dryness (24.2%), tearing (10.1%), and itching (6.1%), while males reported more blurry vision (68.8%) and pain (14.1%). Lower educational attainment was associated with a 2.1-fold increased risk of severe DED. Marital status and ocular comorbidities were not significantly associated with DED.

Conclusion: The prevalence of DED among individuals living with diabetes in Bronkhorstspruit was 81.6%. An increase with age, female sex, and lower educational attainment were identified as factors significantly associated with DED, whereas marital status was not associated with DED. The high prevalence reported underscores the urgent need for context-specific interventions, including community-level awareness, early screening, and tailored management strategies, to mitigate the ocular complications of diabetes. Future studies should explore environmental exposures as additional risk factors.