Diabetes mellitus is a common disease affecting people’s quality of life, and it has the third highest rate of death and disability. The etiology and pathogenesis have not been fully elucidated, and the rapid increase in the number of patients with diabetes is mainly related to the improvement of economic conditions, the increase in life expectancy and the improvement of detection methods. 70% of patients develop small vessel and microangiopathy. Systemic involvement of organs: heart, brain, kidneys, eyes, ocular involvement: eyelids, conjunctiva, cornea, iris, ciliary body, crystals, vitreous, retina, optic nerve, extraocular muscles, orbit, appendages. Diabetic ocular lesions include eyelid: yellow warts, ptosis, subconjunctival hemorrhage, infectious lesions: orbit, appendages, cornea, crystal lesions: cataract, refractive changes, vitreoretinal lesions, neuropathy: peripheral nerve, optic nerve. Fang Zhou, Ophthalmology Department, Qilu Hospital, Shandong University
I. Ischemic optic neuropathy.
Etiology Microcirculatory disorders, local ischemia. Manifestations: more pronounced loss of visual function, decreased visual acuity and visual field defects than in non-diabetic patients. Treatment: control blood sugar, improve microcirculation, supplement vitamins, and use hormones with caution.
II. Diabetic ocular muscle paralysis.
Characteristics: Acute onset, often with recurrence as the main complaint; monocular onset is common;, articular nerve palsy is most common, followed by abducens nerve. Pathologic examination: the myelin sheath of the central part of the nerve is degenerated and lost; patients often have poor glycemic control. Treatment: control blood sugar, improve microcirculation, supplement vitamins, and use hormones with caution.
Refractive changes
(A) Refractive error Mechanism: blood sugar fluctuation, tissue osmotic pressure change, crystal refractive change. Performance: Causes sudden fluctuation of myopia or hyperopia, blurring the vision of both eyes. After the blood glucose is stabilized for a few months, then optometry is performed.
(ii) Adjustment paralysis: Mechanism: Excessive glycogen accumulates in the pigment epithelium of the ciliary body, and the ciliary body becomes edematous, interfering with normal function. Performance: rapid onset, both eyes, normal blood sugar, recoverable.
IV. Cataract
Increased incidence of cataracts in diabetic patients, mostly posterior subcapsular cataracts. Mechanism: multifactorial combined accrual. It manifests as progressive vision loss. Treatment: Early reversible. Late surgery. Prognosis: Affected by retinopathy.