Author: Dr. Luis Felipe Hernández Matute
Diabetes is a major cause of blindness in the world. Furthermore, we see that the incidence of diabetes has increased in recent years as a result of factors such as a sedentary lifestyle, stress, poor eating habits, alcohol consumption, the higher rate of survival of the diabetic population, etc.
It is important to know that diabetes affects all the tissues of our body, therefore the eye can also be altered in many ways. We will briefly review some of the ways in which diabetes affects our eyes:
1. Paralysis of the extra-ocular muscles: This is presented as a deviation in alignment of the eyes or a drooping upper eyelid. In the latter case, the eye is closed and the patient cannot open it. This paralysis is due to the inflammation of the nerves that activate the muscles around the eye due to the sustained elevated levels of blood sugar that occurs in diabetes. Treatment of this type of paralysis is the normalization of glucose levels and administering neurotropic vitamins. Bell's palsy usually resolves completely over a period of 6 to 8 weeks.
2. Refractive changes (graduation of eyeglasses): The sudden elevation of blood glucose causes a change in the shape of the eye lens, which results in a marked increase or decrease in the graduation of the eyeglasses. This causes visual changes and the patient feels very anxious not knowing what is happening to him or her. When diabetes is controlled and the glucose levels return to normal, the lens generally returns to its original shape. Only then the vision and refractive needs stabilize.
3. Cataracts: In diabetic patients the process of clouding of the lens, called cataracts, is accelerated. Cataracts require surgery to restore vision.
4. Glaucoma is one of the most serious complications of diabetes. In addition to having a greater tendency to glaucoma, a diabetic patient may develop a very devastating form of glaucoma: neovascular glaucoma. This type of glaucoma requires a complex drug treatment and surgery to prevent a profound visual loss.
5. Diabetic retinopathy is a condition affecting the micro-circulation in the retina. It is produced by the occlusion of the capillary vessels that leaving the retinal tissue without oxygen. In response to this deprivation of oxygen, the body produces a series of vascular changes ranging from fluid buildup (edema), exudation (deposit of lipoid substances), bleeding and disorderly proliferation of new vessels that end up destroying the retina, with the consequent visual loss. Diabetic retinopathy is clinically divided into two forms:
a) Non-proliferative Diabetic Retinopathy, which is characterized by edema, exudates and retinal hemorrhages. It may be treated with the application of an intraocular drug and / or laser applications, as appropriate.
b) Proliferative Diabetic Retinopathy, which is characterized by neovascular proliferation, membrane formation and hemorrhages extending to the vitreous humor. The membranes can cause a tractional retinal detachment. This is the most advanced stage of damage to the internal structures of the eye. Treatment is complex and includes combinations of different surgical techniques (vitrectomy, membrane removal, replacing the detached retina, etc.), laser application and intraocular drugs. The visual recovery prognosis is limited and depends on the level of tissue damage.
6. Optic Neuritis is a complication where the optic nerve becomes inflamed and therefore causes severely decreased vision. It may be treated with cortico-steroid medications, and recovery may not be complete.
We have reviewed some of the eye complications that often occur in diabetic patients. It is essential to know that if you are diabetic, these are REAL COMPLICATIONS that can happen, but many of these are preventable if you maintain normal blood glucose levels.
A periodic ophthalmologic examination is the best way to detect any abnormal situation at an early stage preventing the terminal stages of the process.