Assessment of Meibomian Gland Function and Tear Film Stability in Type 2 Diabetic Patients

<i>Background: </i>Type 2 Diabetes Mellitus (T2DM) is frequently associated with ocular surface disorders, including dry eye disease (DED) and meibomian gland dysfunction (MGD). Chronic hyperglycemia, systemic inflammation, and autonomic neuropathy may disrupt meibomian gland morphology and tear film composition, contributing to both evaporative and aqueous-deficient dry eye. Understanding these alterations is essential for early detection and intervention in diabetic eye care. <i>Aim: </i>To evaluate meibomian gland function and tear film stability in patients with T2DM and compare these parameters with age- and sex-matched healthy individuals. <i>Methods: </i>This cross-sectional study was conducted at Vision Eye Hospital, Dhaka, Bangladesh, from June 2024 to May 2025. A total of 260 participants were enrolled, comprising 130 T2DM patients (diagnosed per ADA/WHO criteria) and 130 healthy controls. Ethical approval was obtained from the Institutional Review Board, and informed consent was taken from all participants. Data collection included structured ocular history, the Ocular Surface Disease Index (OSDI) questionnaire, and clinical tests such as tear break-up time (TBUT), non-invasive TBUT (NIBUT), Schirmer I test, tear meniscus height (TMH), and non-contact meibography. Statistical analysis was performed using SPSS version 26.0; independent t-tests and chi-square tests were applied, with significance set at p < 0.05. <i>Results: </i>T2DM patients demonstrated significantly worse ocular surface parameters compared to controls. OSDI scores were higher in diabetics (34.6 ± 12.1 vs. 15.3 ± 7.8; p < 0.001), indicating more severe symptoms. Tear film stability was reduced, with lower TBUT (6.1 ± 2.2 s) and NIBUT (5.8 ± 2.4 s) compared to controls (10.3 ± 2.5 s and 11.2 ± 2.7 s; both p < 0.001). Aqueous tear production was impaired, reflected by lower Schirmer I values (9.4 ± 3.8 mm vs. 15.6 ± 4.2 mm; p < 0.001) and reduced TMH (0.18 ± 0.05 mm vs. 0.25 ± 0.06 mm; p < 0.001). Meiboscores were significantly higher in the diabetic group (3.7 ± 1.2 vs. 1.8 ± 0.9; p < 0.001), indicating greater gland dropout. HbA1c and duration of diabetes correlated significantly with meiboscore and tear film parameters (r = –0.41 and +0.43; p < 0.01). <i>Conclusion: </i>T2DM is significantly associated with both meibomian gland dysfunction and tear film abnormalities. Early ocular surface assessment in diabetic patients is recommended to detect subclinical changes and prevent visual discomfort and quality-of-life impairment.