Ocular Surface Changes in patients with Type 2 Diabetes Mellitus: Evidence from Palestine

Purpose:  To determine the ocular surface disease in patients with Type 2 diabetes mellitus (DM) by using translated and validated Arabic version of Ocular Surface Disease Index (Arab-OSDI) and the clinical measurements. Study Design:  Cross-sectional study.Methods:  A total of 30 patients with Type 2DM and 30 non-diabetic controls were included in this study. All participants, who were non-contact lens users, completed the Arab-OSDI questionnaire and underwent clinical evaluations including tear break-up time (BUT), meibomian gland assessments, tear meniscus height (TMH), Marx line (ML), Schirmer II tear test, fluorescein corneal staining (F/S), and lissamine green conjunctival staining (LGS) were recruited. Dry eye (DE) was diagnosed when Arab-OSDI scores were ≥13 and BUT was <5 seconds. Results:  The DM and non-DM groups demonstrated notable differences in the outcomes of Arab-OSDI (p = 0.017) and the evaluations of meibomian gland (p = 0.022). Within the DM group, individuals with dry eye showed significantly elevated Arab-OSDI results compared to those without dry eye (p = 0.014), whereas the other clinical parameters showed no statistically significant differences. Conclusion:  Individuals with Type-2 DM may experience damage to the lacrimal functional unit, leading to tear deficiency or evaporative DE. This altered tear composition may increase DE symptoms, as reflected in elevated Arab-OSDI scores. Keywords:  Ocular surface disease, Diabetes Mellitus, Ocular surface disease index.