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Abstract
Objective: To compare the prevalence of dry eye disease (DED) and corneal nerve sensitivity (CNS) in diabetic and non-diabetic individuals.
Methods: A Comparative cross-sectional study was conducted in the Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan, from January - June 2025. A total of 300 adults aged 40–70 years were enrolled, including 150 patients with diabetes and 150 demographically comparable individuals without diabetes. DED symptoms were assessed using the SPEED questionnaire, and objective assessments included corneal nerve sensitivity, Schirmer’s test and TBUT. Data were analysed using the Mann–Whitney U, Chi-square, and Fisher’s exact tests, with Firth penalised logistic regression used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI).
Results: Diabetic participants had higher HbA1c [7.61(0.94)% vs. 5.37(0.26)%; P<0.001], higher SPEED scores [18.77(2.84) vs. 11.87(1.32); P<0.001], lower Schirmer’s values [6.97(2.26) mm vs. 17.50(0.94) mm; P<0.001], and shorter TBUT [7.21(2.09) s vs. 11.85(1.09) s; P<0.001]. DED and reduced corneal nerve sensitivity were each present in 83.3% of diabetic participants but not in any of the controls (P<0.001). Within the diabetic cohort, longer duration of diabetes independently predicted DED (aOR 1.55 per year; p=0.002).
Conclusion: Diabetes mellitus is strongly associated with DED and corneal nerve dysfunction. Reduced corneal nerve sensitivity may serve as an early marker of diabetic complications, thus supporting routine ocular surface and corneal sensitivity assessments for timely detection and intervention.
Keywords: Diabetes mellitus; dry eye disease; corneal nerve sensitivity; Schirmer tear test; tear film break-up time; HbA1c
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