Corneal changes in patients with diabetes mellitus: clinical implications

Diabetes mellitus (DM) is a major chronic disease and currently a ‘public health priority’ in most countries in the world. 1 India is home to the second-largest population of diabetics in the world with 77 million people in 2019, which is expected to rise to 134.2 million by the year 2045. With continued improvement in health care delivery, the life expectancy is also set to increase in people with DM by about 33% by 2050. 2 The cost involved in the management of DM and its associated complications exerts a great stress on the health care system. 3 DM affects nearly all ocular tissues—the tear film, cornea, crystalline lens, optic nerve, and retina—and is currently the leading cause of legal blindness in adults globally. Although diabetic retinopathy (DR) is usually more prominent and highlighted compared to other ocular complications, corneal issues appear to be more frequent with approximate-ly 70% of examined patients being affected. 4 alterations include leading to epithelial fragility, recurrent erosions, superficial punctate keratitis, epithelial defects, neuropathy manifested by reduced corneal sensitivity and delayed epithelial healing, oedema, increased corneal thickness, increased hysteresis, and endothelial changes. 5