Dry Eye, Loss of Tear Glands Could Indicate Increased HbA1c Levels

Gloria Wu, MD

New data from the Endocrine Society (ENDO) 2020 Annual Scientific Sessions suggests a potential link between the loss of tear glands in eyelids and elevated blood glucose levels in diabetics.

Performed by investigators from the University of California, San Francisco, results of the study indicate loss of meibomian glands in the eyelid could serve as a biomarker for elevated blood glucose levels.

“In this small study, we found that loss of meibomian glands occurred more frequently with elevated hemoglobin A1c, perhaps due to microischemia, or damage to the small blood vessels, of the eyelids,” said investigator Gloria Wu, MD, adjunct faculty at the University of California, San Francisco, in a statement. “Loss of meibomian glands may suggest the need for A1c testing to track average blood glucose levels during the past two to three months and additional monitoring in individuals with diabetes.”

With dry eyes and eye pain a common symptom among diabetic patients, Wu and a team of colleagues sought to assess the impact of loss of meibomian glands in diabetic patients with dry eye. To do so, investigators conducted a retrospective review of data from electronic medical records of patients with and without type 2 diabetes mellitus with a diagnosis of dry eye from 2017-2019.

Inclusion criteria for diabetics included an HbA1c of 5.7% or greater with infrared eyelid imaging performed and 4 weeks of HbA1c lab results as well as the percentage loss of meibomian glands for eye each then averaged for each patient. For controls, inclusion criteria included the absence of diabetes, presence of HbA1c lab results, infrared eyelid imaging, and the percentage loss of meibomian glands for eye then averaged per patient.

Investigators noted individuals were excluded from both groups if they were younger than 18 years old but older than 90 years. Additional exclusion criteria included use of glaucoma topical medications, eyelid surgery, corneal surgery, and conjunctival surgery.

A total of 120 patients were included in the study, including 60 patients with diabetes. The mean age of study participants was 69.6 years while the mean age of diabetics was 65.1 years and the mean age of the control cohort was 54.1 years.

Upon analysis, meibomian gland loss occurred in 51.54% of diabetics compared to just 11.29% of patients in the control group (P <.0001, t-test). Of the 60 patients included in the diabetes cohort, 35 of the 37 patients with HbA1c greater than 6.6% had greater loss of meibomian glands—defined as 40% or more&mdash;compared to 12 of 23 patients with an HbA1c less than 6.5% (P=.0001).

In the control group, 41 of 50 patients with HbA1c levels lower than 5.5% had minimal loss of meibomian glands while 7 of 10 with levels greater than 5.6% experienced greater loss of glands.

“It can be useful to check the eyelids of individuals with diabetes who complain of dry eye,” Wu said. “It is important for people with diabetes and their family members to consider that dry eye and painful ‘sand in the eyes’ feelings may mean they should check their blood sugar and see an ophthalmologist about their eye health, including their eyelids.”

This study, “Tear Glands and the Diabetic Patient: Is It a Biomarker?,” was accepted for presentation at ENDO 2020.