Can nasal septum deviation be one of the factors affecting diabetic retinopathy?



diabetic retinopathy, proliferative diabetic retinopathy, nasal septum deviation, hypoxia


Aim: Information on the extraocular causes of diabetic retinopathy is limited. Therefore, when researching etiology in a patient with diabetic retinopathy, if glucose, blood pressure and cholesterol are normal, other reasons must be investigated. Our aim was to evaluate the effect of nasal septum deviation (NSD) on the presence and severity of diabetic retinopathy in patients with diabetes mellitus. Methods: This prospective case-control study included 100 eyes of 50 patients with only diabetes mellitus (DM+ NSD-, control group) and 120 eyes of 60 patients with DM and nasal septum deviation (DM+NSD+, NSD group). After evaluation of NSD patients using a nasal obstruction symptom evaluation scale (NOSE scale), 22 patients were classified as mild, 21 as moderate, and 17 as severe. Anterior segment and dilated fundus examinations were performed in all patients. Diabetic retinopathy (DR) was classified as mild, moderate, and severe non-proliferative DR and proliferative DR (PDR). Results: The mean age of patients in the NSD and control groups was 58.7 (15.2) years (range: 41–69) and 59.6 (8.1) years (range: 44–67), respectively. The prevalence of DR and PDR were 70% (n=14) and 30% (n=6), respectively, in the severe NSD group (P=0.045 and P=0.035, respectively). The relationship between PDR and other factors in patients with NSD were evaluated, and a correlation was detected with DM duration (P=0.024, OR=1.272), HbA1c (P=0.032, OR=3.085), and NOSE scale severity (P=0.040, OR=2.566). Conclusion: The results of the present study show an increased risk of DR and PDR in patients with severe NSD. In addition to other risk factors in PDR etiology, NSD should also be considered.


Download data is not yet available.


Rosenblatt BJ, Benson WE.Diabetic retinopathy. In: Yanoff M, Duker J, eds. Ophthalmology. 3rd ed. Philadelphia: Mosby. 2009;613e621.

Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol. 2007;14:179-83.

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski J W, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes care. 2012;35(3):556-64.

Xie XW, Xu L, Jonas JB, Wang YX. Prevalence of diabetic retinopathy among subjects with known diabetes in China: the Beijing Eye Study. Eur J Ophthalmol. 2009;19:91-9.

Perumalsamy N, Prasad NM, Sathya S, Ramasamy K. Software for reading and grading diabetic retinopathy: Aravind Diabetic Retinopathy Screening 3.0. Diabetes Care 2007;30:2302–6.

Zhang L, Krzentowski G, Albert A, Lefebvre PJ. Risk of developing retinopathy in Diabetes Control and Complication Trial type 1 diabetic patients with good or poor metabolic control. Diabetes Care. 2001;24(7):1275–9.

Van Leiden HA. Risk factors for incident retinopathy in a diabetic and non-diabetic population: The Hoorn Study. Arch Ophthalmol. 2003;121:245–51.

Stitt AW, Curtis TM, Chen M, Medina RJ, McKay GJ, Jenkins A, et al. The progress in understanding and treatment of diabetic retinopathy. Progre Retin Eye Res. 2016;51:156-86.

Bandello F, Lattanzio R, Zucchaiatti I, Del Turco C. Pathophysiology and treatment of diabetic retinopathy. Acta Diabetol. 2013;50:1–20.

Wang X, Wang G, Wang Y. Intravitreous vascular endothelial growth factor and hypoxia-inducible factor 1a in patients with proliferative diabetic retinopathy. Am J Ophthalmol. 2009;148:883-9.

Van Egmond MM, Rovers MM, Hendriks CT, van Heerbeek N. Effectiveness of septoplasty versus nonsurgical management for nasal obstruction due to a deviated nasal septum in adults: study protocol for a randomized controlled trial. Trials. 2015;16:500.

Ulu S, Ulu MS, Bucak A, Kahveci OK, Yucedag F, Aycicek A. Evaluating the relationship between nasal obstruction and mean platelet volume by using acoustic rhinometry in patients with septum deviation. Rhinology. 2013;51:249–52.

Blum RH, McGowan Jr, F. X. Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications. Pediatric Anesthesia. 2004;14(1):75-83.

Roblin DG, Eccles R. What, if any, is the value of septal surgery? Clin Otolaryngol Allied Sci. 2002;27:77-80.

Onerci CO, Araz SE, Yigit O, Longur ES. Adaptation and validation of the Turkish version of the Nasal Obstruction Symptom Evaluation scale. Int Forum Allergy Rhinol. 2018;8:72-16.

Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130:157-63.

Leske C. Incidence of diabetic retinopathy in the Barbados Eye Studies. Ophthalmology. 2003;110:941–7.

Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, et al.UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia. 2001;44(2):156–63.

Pradeepa R, Surendar J, Indulekha K, Chella S, Anjana RM, Mohan V. Relationship of diabetic retinopathy with coronary artery disease in Asian Indians with type 2 diabetes: the Chennai Urban Rural Epidemiology Study (CURES) Eye Study—3. Diabetes technology & therapeutics. 2015;17(2):112-8.

Aguilar D, Hallman DM, Piller LB, Klein BE, Klein R, Devereux RB, Hanis CL. Adverse association between diabetic retinopathy and cardiac structure and function. American heart journal. 2009;157(3):563-8.

Keen H. The appearance of retinopathy and progression to proliferative retinopathy: The WHO multinational study of vascular disease in diabetes. Diabetologia. 2001;44(Supplement 2):S22–30.

Liu L, Yue S, Wu J, Zhang J, Lian J, Teng W, Chen L. Prevalence and risk factors of retinopathy in patients with or without metabolic syndrome: a population-based study in Shenyang. BMJ open. 2015;5(12).

Chang AC, Fox TP, Wang S, Wu A Y. Relationship between obstructive sleep apnea and the presence and severity of diabetic retinopathy. Retina. 2018;38(11):2197-206.

Giuffre G, Lodato G, Dardanoni G. Prevalence and risk factors of diabetic retinopathy in adult and elderly subjects: The Castedaccia Eye Study. Graefes Arch Clin Exp Ophthalmol. 2004;242(7):535–40.

Krakoff J, Lindsay RS, Looker HC, Nelson RG, Hanson RL, Knowler WC. Incidence of retinopathy and nephropathy in youth-onset compared with adult-onset type 2 diabetes. Diabetes Care. 2003;26(1):76–81.

Arjamaa O, Nikinmaa M. Oxygen-dependent diseases in the retina: role of hypoxia-inducible factors. Exp Eye Res. 2006;83:473-83.

Hirota K, Semenza GL. Regulation of angiogenesis by hypoxia inducible factor 1. Crit Rev Oncol Hematol. 2006;59:15-26.

Aouiss A, Idrissi DA, Kabine M, Zaid Y. Update of inflammatory proliferative retinopathy: Ischemia, hypoxia and angiogenesis. Current research in translational medicine. 2019.

Salam A, Mathew R, Sivaprasad S. Treatment of proliferative diabetic retinopathy with anti-VEGF agents. Acta Ophthalmol. 2011;89(5):405-11.






Research Article

How to Cite

Yaşar E, Kayabasi S. Can nasal septum deviation be one of the factors affecting diabetic retinopathy?. J Surg Med [Internet]. 2020 Dec. 1 [cited 2024 May 18];4(12):1215-8. Available from: