Diabetes can affect the sympathetic innervation of the iris. People with diabetes may exhibit sluggish pupillary reflexes. The pupils may be more miotic and have a weaker reaction to topical mydriatics. Conjunctiva
Microaneurysms in the bulbar conjunctiva are commoner in persons with diabetes. In addition, individuals with diabetes are at an increased risk of developing conjunctival bacterial infections.
Tear Film
Tear film abnormalities are frequent in persons with diabetes, leading to an increased incidence of dry eye. The presence of an abnormal tear film may contribute to discomfort and to an increased risk of ocular surface epithelial defects. Longstanding diabetes may also damage the mircrovascular supply to the lacrimal gland, impairing lacrimation.
Cornea
Corneal wound healing
The cornea of a person with diabetes is more susceptible to injury and slow healing after injury than the cornea of a person without diabetes. They are therefore at a higher risk
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In addition, due to abnormal adhesion of the epithelium to the underlying basement membrane, persons with diabetes experience delayed re-epithelization of the cornea. Iris
Neovascularization of the iris (Rubeosis iridis)
Neovascularization of the iris (NVI) is a serious complication characterized by a growth of new blood vessels. These vessels are commonly first observed at the pupillary margin, but may be present in the filtration angle without any visible vessels on the pupil border. NVI can involve the entire iris surface and angle.
If this NVI progresses, a fibrovascular network of vessels could grow over the iris tissue and into the filtration angle of the eye. The new vessels and accompanying fibrosis may occlude the trabecular meshwork, causing neovascular glaucoma.
Lens
People with diabetes are twice as likely to suffer from cataracts or glaucoma than the general population (British Medical Journal, 2000).