Eyelid selfies can warn of elevated glucose levels with dry eye
With the use of infrared images of the inside of the lower eyelids, researchers determined that higher glucose levels are associated with loss of meibomian glands that are crucial for tear film production, according to study results accepted for presentation at the Endocrine Society Annual Meeting and delivered in a virtual press conference.
The meibomian glands, which appear as vertical striations lining the inside of the eyelid, produce the lipid layer of tear film. This layer, together with a middle aqueous layer produced by the lacrimal gland and a glycoprotein inner layer made by the cornea, is required for the tear film to keep the eye lubricated, according to presenter Gloria Wu, MD, a clinical faculty member in the ophthalmology department at the University of California, San Francisco.
“If you’re missing any of these layers, you will have dry eye and some discomfort — some people have severe discomfort and pain,” Wu said. “Seven percent [of people] in the United States have dry eye, 16.8 million people, and 57% of type 1 diabetics and 70% of type of 2 diabetic patients have dry eye and complain of dry eye.”
Wu and colleagues conducted a retrospective chart review of 120 consecutive patients presenting with dry eye from 2017 to 2019. All patients underwent infrared imaging of their eyelids with the 820 nm wavelength Heidelberg Spectralis imaging platform. None of the participants had glaucoma or eyelid or cornea surgery. Among the cohort, 60 had diabetes (30 women; mean age, 65.1 years; age range, 36-85 years; HbA1c 6%), and 60 without diabetes served as controls (23 women; mean age 54.1 years; age range, 23-89 years; HbA1c 5.7%).
Loss of meibomian glands was greater among the diabetes group, which had a mean of 51.54% of the glands missing, compared with 11.29% among controls (P < .0001). Higher HbA1c was associated with greater meibomian gland loss. Of the 37 patients with HbA1c greater than 6.6%, 35 had more than 40% meibomian gland loss vs. 12 of the 23 patients with HbA1c between 6% and 6.5% (P = .0001).
Professional imaging equipment is not needed for evaluating the number of meibomian glands, according to Wu. Many newer smartphones can take adequate black-and-white infrared photos.
“In the future, we hope you’ll take your iPhone 10, iPhone 11, Samsung 10, flip your own eyelids [and] look at your meibomian glands,” Wu said. “We hope that in other clinics, in rural health clinics, in community health centers, we can use this device that people have and evaluate when people complain of dry eye and they have diabetes, and consider sending them for more diabetic monitoring and looking at their HbA1c.” – by Jill Rollet
Wu G, et al. MON-704. The Endocrine Society Annual Meeting; 2020 (conference canceled/virtual meeting).
Disclosure: Wu reports no relevant financial disclosures.