The extra-renal ocular complications of diabetes mellitus. Current concepts of pathogenesis and management

Abstract

Diabetes mellitus may affect any part of the visual system. Common ocular complications of diabetes include blepharoptosis which may resolve spontaneously, respond to topical phenylephrine or eventually require surgical correction. Increased glucose content of the tears occurs in diabetes without any apparent structural abnormality. Fusiform and saccular aneurysms are a common finding in the bulbar conjunctiva of diabetics, in individuals suffering from other diseases and in persons who are apparently healthy. Decreased corneal sensitivity often with small epithelial pits and folds in Descemet's membrane are also common findings in diabetics. Open angle glaucoma appears to have only a chance association with diabetes while diabetic iridopathy, changes in refractive power and cataract are more closely allied with abnormalities in carbohydrate metabolism.Rubeosis iridis with secondary organization and occlusion of the aqueous humor outflow channels is one of the disastrous complications of diabetes mellitus. Diabetic ophthalmoplegia, another poorly understood phenomenon, may falsely suggest the presence of intracranial aneurysm, tumor or other space occupying mass resulting in needless diagnostic tests. The physician who manages diabetic patients should recognize these abnormalities, the fact that many are harmless and require no treatment, that some are easily treated by simple medical or surgical measures and that others are catastrophies for which no satisfactory therapy is at hand.