Ocular surface changes associated with obesity, prediabetes and diabetes
| Ocular structure | Obesity | Prediabetes | Diabetes |
| Corneal endothelium | NR | NR | Decreased cell density Increased pleomorphism Increasd polymegathism) Increase in auto-fluorescence |
| Corneal stroma (thickness) | Increased thickness | NR | Increased thickness Increased stiffness (hysteresis) |
| Corneal nerve and DCs | NR | Decreased subbasal nerve density | Decreased subbasal nerve density Decreased mechanical, thermal and chemical sensitivity Increased DC density in the central cornea |
| Corneal epithelium | NR | NR | Increased risk of neurotrophic keratitis and ulceration Increased number and persistence of defects Decreased wound healing Decreased basal and wing cell density Thickened basement membrane |
| Conjunctiva | Increased cell metaplasia Decreased goblet cell density | Increased cell metaplasia Decreased goblet cell density | Increased cell metaplasia Decreased goblet cell density Increased hyperemia Increased conjunctival microvasculopathy |
| Eyelids and Meibomian glands | NR | NR | Increased Meibomian gland dysfunction Increased blepharitis |
| Ocular surface microbiome | NR | NR | Increased risk of acute bacterial conjunctivitis Increased levels of positive bacterial culture Increased bacterial diversity |
| Tear function and eye symptoms | NR | NR | Decreased tear volume Decreased tear break-up time Increased osmolarity Increased symptoms of dry eye and discomfort |
DC, dendritic cells; NR, not reported.