No relation between the severity of corneal nerve, epithelial, and keratocyte cell morphology with measures of dry eye disease in type 1 diabetes

Maryam Ferdousi, Ioannis N. Petropoulos, Alise Kalteniece, Shazli Azmi, Georgios Ponirakis, Nathan Efron, Handrean Soran, Rayaz Ahmed Malik

Research output: Contribution to journalArticle

2 Citations (Scopus)


PURPOSE. Patients with diabetes have a propensity to develop dry eye symptoms (DES), with reduced tear secretion and corneal sensitivity. The underlying pathologic basis of DES was explored in patients with Type 1 diabetes. METHODS. Forty-two patients with Type 1 diabetes mellitus (T1DM) (age: 49.21 ± 2.53 years, duration of diabetes: 29.98 ± 2.64 years) and 25 control subjects (age: 48.70 ± 2.84 years) underwent assessment of DES using a validated dry eye questionnaire, and tear stability and tear production were assessed using tear breakup time (TBUT) and Schirmer’s test, respectively. Corneal confocal microscopy was undertaken to quantify corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), keratocyte density (KD), and corneal epithelial basal cell (CEBC) density and area. RESULTS. The prevalence of DES was significantly higher (P = 0.03), and TBUT (P = 0.006), corneal sensation (P < 0.0001), CNFD (P = 0.001), CNBD (P = 0.001), CNFL (P = 0.003), and KD (P = 0.04) were significantly lower in patients with T1DM compared to control subjects. However, these measures did not differ significantly between T1DM patients with and without dry eye. There was no correlation between DES and TBUT or corneal nerve keratocyte and CEBC morphology. CONCLUSIONS. DES and TBUT are significantly increased in patients with T1DM, but are not related to corneal nerve, basal epithelial, or keratocyte cell morphology.

Original languageEnglish
Pages (from-to)5525-5530
Number of pages6
JournalInvestigative Ophthalmology and Visual Science
Issue number13
Publication statusPublished - Nov 2018



  • Corneal confocal microscopy
  • Corneal epithelial basal cells
  • Corneal nerves
  • Dry eye
  • Keratocytes
  • Type 1 diabetes mellitus

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this