Diabetes and the eye👀

Types of eye pathology associated with diabetes:

Glaucoma: earlier debut is noticed in patients with DM.
Symptoms typical of acute glaucoma include an acutely red, painful eye with reduced vision. Occurs when new blood vessels hm grow in the iris and block the drainage of fluid.

Rubeotic glaucoma occurs when new blood vessels that are abnormal grow on the iris and block the drainage of fluid, leadingsecondary to raised intraocular pressure. High intraocular pressure can cause headache, nausea, and vomiting.

Diabetic retinopathy that is uncontrolled and proliferative is a common cause of rubeotic glaucoma

Bilateral diabetic papillopathy: a reduction in visual acuity that is sudden, does not fluctuate, and does not improve with a pinhole. A relative afferent pupillary defect may be present if one eye is affected more severely than the other. Direct ophthalmoscopy would reveal swollen discs.

Bilateral macular oedema (exudate within the macula) presents as a a gradual decline in central vision. Some patients describe missing patches of text when they read. 

Variable refractive change:  it is caused by fluctuations and rapid reduction of blood glucose that may alter the composition and thickness of lens (lens hydration). It may manifest with:blurred  vision when driving, watching TV,   reading 

Bilateral cataracts: patients with DM tend to develop cataract earlier than those without DM. It results in a gradual decline in vision.

They classically cause patients to experience a glare with oncoming headlights while driving at night.

Vitreous haemorrhage may occur in patients with diabetes who have proliferative retinopathy (when retinal tissue becomes hypoxic new blood vessels form - proliferative diabetic retinopathy). Bleeding occurs from new vessels at the optic disc or elsewhere. 

Screening for retinopathy should be done in the begging (when DM 1 or 2 is diagnosed) and every 2 years afterwards.