To evaluate changes in the tear film lipid layer thickness (LLT) in cataract patients with diabetes mellitus (DM) after cataract surgery.
We recruited consecutive cataract patients and recorded data regarding DM condition. Lipid layer thickness (LLT) and partial blinks rates measured with the LipiView interferometer, tear break-up time (TBUT) and Schirmer’s tests, and dry eye symptoms evaluated with the Ocular Surface Disease Index (OSDI) questionnaire were conducted before and one month after cataract surgery.
Finally, 38 age-related cataract (ARC) and 31 diabetic cataract (DC) patients were available for analysis. No significant difference in preoperative LLT and partial blink rates was found between ARC and DC group. However, preoperative TBUT and Schirmer’s test results were significantly lower in DC group compared to ARC group (both p < 0.001). DC group showed higher preoperative OSDI score with no significant difference than ARC group (p = 0.279). In DC group, LLT was significantly thinner in cases with longer duration of DM (over 10 years) than in those with shorter duration (p  0.05). Ocular Surface Disease Index (OSDI) scores were significantly higher after surgery than at baseline in both ARC (pre: 8.9 ± 8.4, post: 12.4 ± 8.5, p = 0.003) and DC group (pre: 11.4 ± 10.3, post: 18.5 ± 8.5, p = 0.001). Multivariate linear regression analysis showed OSDI scores were associated with LLT either before or after cataract surgery (β = -0.862, p < 0.001 and β = -0.592, p < 0.001, respectively).
The tear film LLT is correlated with duration of DM and becomes significantly thinner one month after cataract surgery, leading to the aggravation of dry eye symptoms.

© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.