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World J Clin Cases. Jun 6, 2023; 11(16): 3736-3749
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3736
Diabetes more than retinopathy, it’s effect on the anterior segment of eye
Arvind Kumar Morya, Prasanna Venkatesh Ramesh, Kirandeep Kaur, Bharat Gurnani, Aarti Heda, Karan Bhatia, Aprajita Sinha
Arvind Kumar Morya, Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
Prasanna Venkatesh Ramesh, Glaucoma and Research, Mahathma Eye Hospital Private Limited, Tennur, Trichy 620001, Tamil Nadu, India
Kirandeep Kaur, Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Sadguru Seva Sangh Trust, Janaki-Kund, Chitrakoot 485334, Madhya Pradesh, India
Bharat Gurnani, Cornea and Refractive Services, Sadguru Netra Chikitsalaya, Sadguru Seva Sangh Trust, Janaki- Kund, Chitrakoot 485334, Madhya Pradesh, India
Aarti Heda, Department of Ophthalmology, National Institute of Ophthalmology, Pune 411000, Maharashtra, India
Karan Bhatia, Department of Ophthalmology, Manaktala Eye and Maternity Home, Meerut 250001, Uttar Pradesh, India
Aprajita Sinha, Department of Ophthalmology, Worcestershire Acute Hospital, Worcestershire 01601, United Kingdom
Author contributions: Morya AK and Venktash P contributed equally to writing and editing the manuscript; Kaur K and Gurnani B downloaded the relevant articles from the RCA system and other Pubmed and Embase databases; Heda A, Sinha A, and Bhatia K contributed to writing a few sub-speciality sections and provided original images and tables.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Arvind Kumar Morya, MBBS, MNAMS, MS, Additional Professor, Department of Ophthalmology, All India Institute of Medical Sciences, 110 Arya Nagar, Sardhana Road, Hyderabad 508126, Telangana, India.
Received: March 23, 2023
Peer-review started: March 23, 2023
First decision: April 11, 2023
Revised: April 25, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 6, 2023

Diabetes mellitus (DM) is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics. It threatens healthy life around the globe, with mild-to-severe secondary complications and leads to significant illness including nephropathy, neuropathy, retinopathy, and macrovascular abnormalities including peripheral vasculopathy, and ischaemic heart disease. Research into diabetic retinopathy (DR), which affects one-third of persons with diabetes, has made considerable strides in recent years. In addition, it can lead to several anterior segment complications such as glaucoma, cataract, cornea, conjunctiva, lacrimal glands and other ocular surface diseases. Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells, which raises the likelihood of anterior segment diseases including corneal ulcers, dry eye disease, and chronic epithelial abnormalities. Although DR and other associated ocular complications are well-known, the complexity of its aetiology and diagnosis makes therapeutic intervention challenging. Strict glycaemic control, early detection and regular screening, and meticulous management is the key to halting the progression of the disease. In this review manuscript, we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology, epidemiology, and prospective therapeutic targets. This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes, which are often neglected.

Keywords: Diabetes, Ocular surface, Cataract, Glaucoma, Lens, Uvea

Core Tip: Most of the review articles and meta–analysis on diabetes and ocular science are focused on diabetic retinopathy and posterior segment only. To the best of our knowledge, this is the first such review article on the effect of diabetes on the anterior segment of the eye. It gives a detailed insight into the intricate pathophysiology of the adverse effect of diabetes on the eye-appendages, cornea, lens and uvea of the eye.