Psoriasis is a chronic autoimmune condition affecting the skin, with potential implications for eye health. Knowing the eye manifestations in psoriasis helps patients and their families navigate and manage the condition and prevent serious complications.
In this article, Ophthalmology24 shares an overview of the psoriasis eye symptoms, the causes, diagnostic methods, and treatments.
Psoriasis and Its Systemic Nature
Psoriasis is an inflammatory condition of an overactive immune response, leading to rapid skin cell turnover.
Hence the formation of thick, scaly patches on the skin. What's interesting is, psoriasis is not limited to the skin. It can affect multiple organ systems.
Approximately 10-30% of individuals with psoriasis may experience eye-related symptoms.
Can You Have Psoriasis in Your Eyes?
Psoriasis does NOT directly affect the eyes. So no, your eyeballs will not start flaking up like your skin does if you have psoriasis. However, the condition can manifest around the eyes, triggering several eye conditions, some of which are quite serious.
In most cases, those are blepharitis (eyelid inflammation), conjunctivitis (conjunctiva inflammation), uveitis (uvea inflammation), keratitis (corneal inflammation), and dry eye syndrome. They may result from the systemic immune response brought about by psoriasis.
Common Eye Manifestations in Psoriasis
Blepharitis
Blepharitis is an eyelid inflammation, commonly occurring at the eyelashes base. The signs are red, swollen, and itchy eyelids, crusting and flaking of the skin around the eyes, sensitivity to light, or a burning sensation.
Blepharitis may be a sign of irritation due to psoriasis. It leads to discomfort and secondary infections if not properly managed.
Conjunctivitis (Pink Eye)
Inflammation of the thin layer covering the eye's white part and the eyelids' inner lining. Redness, itching, burning sensation, discharge from the eyes, and tearing are telling signs of pink eye.
Psoriasis-related conjunctivitis can cause extreme discomfort and may be recurrent, indicating ongoing systemic inflammation.
Uveitis
Uveitis is an inflammation of the eye's middle layer, which includes the iris, ciliary body, and choroid. Symptoms of uveitis are eye pain, redness, blurred vision, sensitivity to light, and floaters.
Uveitis is a serious condition, potentially causing vision loss if not treated on time. It often indicates a more severe form of psoriatic disease.
Keratitis
Keratitis is a corneal inflammation, affecting the dome-shaped surface covering the front of the eye. Eye pain, redness, blurred vision, light sensitivity, and excessive tearing may sometimes indicate keratitis.
The severe irritation can result in scarring and vision loss without prompt treatment. Keratitis often requires immediate medical attention.
Dry Eye Syndrome
Dry eye is a condition where the eyes don't produce enough tears or tears evaporate too quickly. People with dry, scratchy, or gritty sensations in the eyes, notice redness, photophobia, and blurry vision, often have dry eyes.
Chronic inflammation from psoriasis may affect the tear glands, aggravating dry eye syndrome.
Possible Causes of Psoriasis Eye Problems
1. Immune System Dysregulation
Probability: High
Psoriasis is driven by an overactive immune system, mistakenly attacking healthy tissues, including the eye tissues.
Given psoriasis is an autoimmune condition, immune dysregulation is a primary cause of associated psoriasis eyes symptoms.
2. Chronic Inflammation
Probability: High
Persistent inflammation from psoriasis can extend to ocular tissues. Thus leading to certain eye conditions.
Chronic inflammation is a hallmark of psoriasis and is very likely to imply eye manifestations.
3. Genetic Predisposition
Probability: Moderate to high
Genetic factors play a role in psoriasis development and may influence susceptibility to psoriasis eye problems.
Genetic predisposition is a known factor in psoriasis, which may extend to eye manifestations.
4. Environmental Triggers
Probability: Moderate
External factors, infections, stress, and chemical exposure may aggravate eye psoriasis symptoms.
But while environmental triggers can worsen the condition, they are usually not the sole cause of psoriasis eye problems.
5. Coexisting Conditions
Probability: Moderate
Psoriasis often coexists with other conditions like arthritis (psoriatic arthritis) and metabolic syndrome, which can also affect eye health.
Comorbid conditions can contribute to the severity and frequency of eye issues in psoriasis patients.
Diagnosis of Eye Manifestations in Psoriasis
Diagnosing eye problems from psoriasis calls for a complete medical history, detailed eye examination, and diagnostic tests.
Key diagnostic steps include:
Medical History: Documenting and reviewing the patient's history of psoriasis, including onset, duration, and severity of skin symptoms, as well as any previous eye issues.
Ophthalmic Examination: Conducting an eye exam with visual acuity testing, slit-lamp examination, and intraocular pressure measurement.
Laboratory Tests: Evaluating inflammatory markers (e.g., ESR, CRP), autoimmune markers (e.g., ANA, HLA-B27), and tear production tests (e.g., Schirmer's test).
Imaging Studies: Utilizing optical coherence tomography (OCT), fluorescein angiography, and other imaging modalities to assess eye inflammation and structural changes.
RELATED: What to Expect During an Eye Exam?
Treatment Options for Eye Manifestations in Psoriasis
Managing eye manifestations in psoriasis demands a multidisciplinary approach. That's involving a dermatologist and an ophthalmologist.
Treatment options for psoriasis eye problems include:
Topical Treatments for Eye Psoriasis Issues
Corticosteroids in the form of eye drops or ointments to reduce inflammation
Antibiotic ointments to treat secondary bacterial infections from blepharitis
Systemic Treatments for Ocular Problems from Psoriasis
Immunosuppressants such as methotrexate, cyclosporine, or biologics (e.g., TNF inhibitors) to control systemic inflammatory response
Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and eye inflammation
Lifestyle Modifications
Eye hygiene and regular eyelid cleaning to manage and avoid infections
Avoiding triggers that intensify eye symptoms
Artificial tears to alleviate dry eye syndrome from psoriasis
Warm compresses to relieve discomfort from blepharitis
Surgical Interventions for Severe Eye Manifestations in Psoriasis
Surgical ocular intervention may be required in some rare instances to address severe complications
Monitoring Psoriasis and Eye Problem Preventive Strategies
Regular monitoring of eye health makes a huge difference for psoriasis patients. Individuals should not miss routine eye checkups, especially if they have new or worsening eye symptoms. Early referral to an ophthalmologist is a game-changer and vision-saver.
There is also the need for coordination between dermatologists and ophthalmologists for effective control of both skin and eye manifestations in psoriasis.
Conclusion
By staying aware and proactive, patients with psoriasis can work closely with their doctors to maintain both their skin and eye health. Leading to a better quality of life and lower risk of complications.
Resources:
Can Psoriasis Cause Eye Problems?, Very Well Health
Identifying and Treating Ocular Manifestations in Psoriasis, SpringerLink
Checked by Atanas Bogoev, MD.