To determine the relationship between changes in the tear film according to the classification of diabetic retinopathy in patients with diabetes.

A total of 117 newly detected diabetic patients were included in this study. The classification of diabetic retinopathy was performed based on the Early Treatment Diabetic Retinopathy Study (ETDRS). The duration of diabetes and HbA1c were also investigated in patients who had undergone panretinal photocoagulation or insulin treatment. To examine the tear film function, we performed the tear break-up time test, the Schirmer I test, and the diagnostic fluorescein staining test of the ocular surface. The Cochet-Bonnet esthesiometer was also employed to examine the corneal sensitivity.

As the severity of diabetic retinopathy progressed, the degree of ocular surface fluorescein staining increased significantly. There was no relationship between the duration of diabetes and the results of the tear film function test. Patients who had high blood HgA1c levels showed significant increases in tear break-up time and degree of ocular surface fluorescein staining. The patients who had undergone panretinal photocoagulation showed significant differences in tear break-up time and degree of ocular surface fluorescein staining.

The diabetic patients with progressed diabetic retinopathy, uncontrolled blood HgA1c levels and who had previously undergone panretinal photocoagulation should be managed more carefully since those patients are more susceptible to ocular surface disorder with aggravation of tear film function.