Medically Reviewed by a Doctor on 11/5/2014

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Andrew A. Dahl, MD, FACS
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Diabetic Eye Disease Causes

Patient Comments Share Your Story
Over many years, high blood sugar (hyperglycemia) and other abnormalities in metabolism
found in people with diabetes may damage the blood vessels in the body. This damage to the
blood vessels leads to poor circulation of the blood to various parts of the body. Since the
function of the blood is to carry oxygen and other nutrients, this poor circulation causes
decreased oxygen delivery to tissues in different parts of the body and subsequent damage to
those tissues.
Some of the most sensitive tissues to decreased blood flow and oxygen delivery include the
brain, heart, kidneys, and the eyes. Lack of adequate oxygen delivery to these areas causes
strokes, heart attacks, kidney failure, and vision loss.
Feet and Lower Legs
The feet and lower legs can also suffer from poor blood circulation and oxygen delivery,
resulting in symptoms of:

Numbness and tingling

Poor healing of even minor wounds

Ulceration and infection

Not infrequently, the need for amputation of a toe, a foot, or the lower leg.

The Retina
The primary part of the eye affected by diabetes is the retina.
The retina can be thought of as the film in a camera. If the film in a camera is faulty, the resulting
picture will be blurry. In a similar manner, if the retina of the eye is swollen, wrinkled, or
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Medically Reviewed by a Doctor on 11/5/2014

Medical Author:
Andrew A. Dahl, MD, FACS
Medical Editor:
Melissa Conrad Stppler, MD, Chief Medical Editor
Next Page:
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otherwise structurally damaged, the vision in that eye will be blurry. Depending on the type,
location, and extent of damage in the retina, the change in vision will range from minimal to
severe and be temporary or permanent.

In people with diabetes, changes in the walls of the small blood vessels in the retina are
caused by blood sugar abnormalities. These small blood vessels may begin to "balloon,"
forming what are called microaneurysms, as well as leak fluid (called microaneurysms, as
well as leak fluid (called edema) and blood (called dot and blot hemorrhages) into the
retina. This process is called background diabetic retinopathy or nonproliferative
diabetic retinopathy. If fluid accumulates in the central part of the retina (called the
macula) and causes swelling there, the process is called diabetic macular edema.

As a response to decreased oxygen delivery to the retina, new blood vessels may begin to
grow, a process called proliferative diabetic retinopathy. Although new blood vessels
may sound like a good thing, considering that the old blood vessels are damaged, the new
blood vessels are actually more harmful than beneficial. The new blood vessels are
extremely leaky and fragile, potentially leading to bleeding inside the eye (called vitreous
hemorrhage) and usually resulting in severe vision loss. If not treated appropriately, this
vision loss may be permanent.
o If the new blood vessels are extensive, they may cause scarring inside the eye,
resulting in tractional retinal detachments, which is another cause of permanent
vision loss.
o In cases of severe proliferative diabetic retinopathy, new blood vessels may grow
on the surface of the iris, causing neovascular glaucoma, a particularly severe
form of glaucoma.
o Many people with diabetes may notice that their vision becomes blurry when they
have fairly large, rapid shifts in their blood sugar levels. This temporary blurring
is because the sugar in the blood can diffuse into the lens of the eye and cause it to
swell, thus changing the focal point of the eye and resulting in blurring of the
vision. Over time, repeated swelling of this type is thought to damage the lens and
cause it to become cloudy, resulting in a cataract.

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Medically Reviewed by a Doctor on 11/5/2014

Medical Author:
Andrew A. Dahl, MD, FACS
Medical Editor:
Melissa Conrad Stppler, MD, Chief Medical Editor
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o The high blood sugar levels may also eventually damage the cells lining the
trabecular meshwork toward the front of the eye, where the fluid (called aqueous
humor) flows out from within the eye. When these cells are damaged, the
trabecular meshwork cannot function correctly. If the trabecular meshwork does
not function correctly, the fluid cannot flow out of the eye properly and the
pressure inside the eye can increase. This high pressure inside the eye can damage
the optic nerve and cause permanent vision loss. This process is called glaucoma.
Diabetic eye disease can cause a wide range of problems that affect the eyes, in particular the
retina, the lens, and the trabecular meshwork.

Picture of the structures of the eye

Medically Reviewed by a Doctor on 11/5/2014
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Medical Editor:
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Medically Reviewed by a Doctor on 11/5/2014

Medical Author:
Andrew A. Dahl, MD, FACS
Medical Editor:
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Efek penyakit diabetes pada mata. (patofisiologis) sumber di header note.

Kelainan metabolism yang terjadi pada diabetes antara lain peningkatan

kadar gula darah dalam jangka panjang dapat merusak endotel pembuluh
darah di tubuh. Kerusakan endotel pada pembuluh darah yang terjadi di
pasien diabetes mellitus tentu akan memberikan efek hipoksia ke jaringan
yang akan berakhir dengan kerusakan jaringan tersebut. Beberapa jaringan
tubuh sangat sensitive terhadap keadaan hipoksia ini jaringan tersebut
adalah jaringan pada otak, jantung, ginjal dan mata.
Hipoksia pada jaringan mata akan menyebabkan kebutaan.
RETINA
Efek primer dari diabetes pada organ mata ditemukan pada retina. Retina
dapat diibaratkan sebagai film dari sebuah kamera. Jika film ini mengalami
kerusakan maka akan member efek pada penglihatan yang buram. Kelainan
lain yang menyebabkan penglihatan menjadi buram dapat juga berupa
pembengkakan pada retina, timbulnya sikatrik kerutan pada retina dan
kerusakan struktur pada retina. Berdasarkan tipe, lokasi dan bentuk
kerusakannya pada retina derajat kebutaan bisa ringan sampai berat.
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Medically Reviewed by a Doctor on 11/5/2014

Medical Author:
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Medical Editor:
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Orang dengan diabetes akan mengalami perubahan mikrovaskular

oleh karena kadar gula darah yang abnormal. Kerusakan mikrovaskular
yang terjadi biasanya diawali dengan proses balloning atau
mikroaneurisma yang menyebabkan terjadinya rembesan cairan atau
edem dan perdarahan pada retina keadaan ini disebut sebagai fase
nonproliferatif diabetik retinopati. Jika terjadi akumulasi di bagian

makula disertai edem makula fase ini disebut makular edema.

Untuk merespon keadaan hipoksia jaringan, maka terbentuklah
pembuluh darah yang baru, fase ini disebut proliferatif. Pembentukan
pembuluh darah baru yang bertujuan untuk meningkatkan oksigenasi
jaringan ini adalah justru awal dari sebuah fase yang bahaya, karena
pembuluh darah yang baru ini sangat rentan dan dapat berpotensi
menjadi penyebab dari vitreus hemoragik yang biasanya akan
berujung penurunan visus yang berat. dan jika pasien pada fase ini
tidak mendapatkan pertolongan yang tepat dapat terjadi kebutaan
permanent.
o Komplikasi lain yang bisa terjadi setelah terbentuk pembuluh
darah yang baru adalah jika pertumbuhan pembuluh darah ini
jumlahnya terlalu banyak maka akan menyebabkan luka pada

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Medically Reviewed by a Doctor on 11/5/2014

Medical Author:
Andrew A. Dahl, MD, FACS
Medical Editor:
Melissa Conrad Stppler, MD, Chief Medical Editor
Next Page:
Diabetic Eye Disease Treatment
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e_disease_diagnosis

bagian dalam mata sehingga retina bisa terlepas , sehingga

berakhir menjadi buta permanen
o Pada keadaan proliferatif diabetik yang berat, pembuluh darah
dapat juga terbentuk di permukaan iris menyebabkan glaukoma

neurovaskular.
Kebanyakan orang dengan diabetes mungkin mengalami penurunan
ketajaman penglihatan, ketika kadar gula darahnya cukup tinggi.
Penurunan ketajaman mata pada pasien diabetes ini terjadi karena
kadar gula darahnya yang tinggi dapat berdifusi ke lensa mata dan
menyebabkan lensa tersebut menjadi membengkak. Efek dari edem
pada lensa adalah perubahan fokus lensa yang turut serta mengubah
ketajaman penglihatan. Seiring dengan waktu jika keadaan ini terjadi
terus menerus dan berulang maka akan merusak lensa mata menjadi

tampak berkabut seperti pada katarak.

Kadar gula darah yang tinggi juga dapat merusak jaringan trabekula
yang berada di bagian mata depan, jaringan ini mengalirkan aquos
humor keluar dari mata. jika jaringan ini rusak maka aliran aquos
humor akan terganggu sehingga terjadi peningkatan tekanan
intraokular. Tekanan intraokular yang meningkat dalam mata dapat

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Medically Reviewed by a Doctor on 11/5/2014

Medical Author:
Andrew A. Dahl, MD, FACS
Medical Editor:
Melissa Conrad Stppler, MD, Chief Medical Editor
Next Page:
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merusak saraf optik mata dan menyebabkan kebutaan permanen.

Keadaan ini disebut glaukoma

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