Structure-wise eye lesions with symptoms & presentations (simplified) are as follows:
- Lids. Xanthelasma (yellow whitish lesion found most commonly on upper eyelid) and recurrent style (small lid nodules) or internal hordeolum.
- Conjunctiva. Telangiectasia, sludging of the blood in conjunctival vessels (pink or bleary eyes) and subconjunctival hemorrhage (fresh bloody red irregular spots noted in the white area of eye).
- Cornea. Pigment dispersal at back of cornea, decreased corneal sensations (due to trigeminal neuropathy), punctate kerotapathy, Descemet’s folds, higher incidence of infective corneal ulcers and delayed epithelial healing due to abnormality in epithelial basement membrane (presenting as watering , pain and blurring of vision)
- Iris. Rubeosis iridis (neovascularization i.e new leaky vessels of iris)
- Lens. Snow-flake cataract in patients with IDDM (insulin dependent diabetes mellitus). Posterior sub capsular cataract. Early onset and early maturation of senile cataract.
- Vitreous. Vitreous haemorrhage (sudden dimension of vision, multiple floaters) and fibre- vascular proliferation secondary to diabetic retinopathy.
- Retina. Diabetic retinopathy and lipaemia retinalis (painless progressive visual loss).
- Intraocular pressure. Increased incidence of POAG (primary open angle glaucoma), neovascular glaucoma. Hypotony(low Intraocular pressure IOP) in diabetic ketoacidosis (due to increased plasma bicarbonate levels)
- Optic nerve. Optic neuritis(sudden decrease of vision over few days).
- Extraocular muscles. Ophthalmoplegia(weakness or paralysis of eye muscles) due to diabetic neuropathy(visual doubling, lid drop, pupil dilatation & squint).
- Changes in refraction. Hypermetropic (increased plus number in glasses) shift in hypoglycemia(low blood sugar levels), myopic shift(increased minus number in glasses) in hyperglycemia(high blood sugar level) and decreased accommodation(difficulty in near work or reading).
Regular & complete eye check up by an ophthalmologist is sincerely advised to all diabetic patients.
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