Ocular Involvement with Psoriasis

Ocular symptoms may occur in approximately 10% of psoriasis patients. Ocular involvement is more common in men than in women. It is rare to have involvement of the eye prior to skin involvement of psoriasis. The incidence of ocular psoriasis can vary widely, and may include such ocular conditions as Blepharitis, Conjunctivitis, Uveitis and Iritis as well as reported cases of secondary corneal involvement resulting in keratitis.

Blepharitis is the most prevalent ocular occurrence in psoriasis. Erythema, edema, and psoriatic plaques may develop. When psoriasis affects the eyelids, scales may cover lashes. The edges of the eyelids may become red and crusty. If inflamed for long periods, the rims of the lids may turn up or down. If the rim turns down, lashes can rub against the eyeball and cause irritation. It usually causes burning, itching, and irritation of the lids. Other common symptoms include sandy, itchy eyes, red and/or swollen eyelids, crusty, flaky skin on the eyelids, and dandruff. In severe cases, this ocular condition may also cause sties, irritation, and inflammation of the cornea leading to keratitis and conjunctiva (conjunctivitis). Blepharitis, usually a chronic problem, can be controlled with extra attention to lid hygiene. However, it may also be caused by an infection, which would require treatment with a prescription medication. The key to controlling blepharitis is to keep the eyelids and eye lashes clean. Remember to remove all mascara and make-up before going to bed.

Conjunctivitis, also known as pinkeye, is an inflammation of the conjunctiva, the thin, clear tissue that lies over the white part of the eye and lines the inside of the eyelid. Viruses, bacteria, irritants such as shampoos, dirt, smoke, and pool chlorine cause conjunctivitis, and allergies such as dust, pollen, or an allergy specific to contact lens wearers. The actual symptoms of conjunctivitis may differ slightly based on the cause of the inflammation, but may include redness in the white of the eye or inner eyelid, an increase in tear production, a thick yellow discharge that crusts over the eyelashes, especially after sleep, green or white discharge from the eye, an itchy or burning sensation in the eyes, blurred vision and/or an increased sensitivity to light. This type of ocular psoriatic conjunctivitis usually occurs in association with eyelid margin involvement during a psoriasis breakout. Psoriatic plaques can extend from the lid onto the conjunctiva area of the eye.

Another area of ocular involvement with psoriasis is Uveitis. This type of inflammation generally results as a complication of psoriatic arthritis. Uveitis is an inflammation of the uvea, the middle layer of the eye's surface. The uvea includes the iris, the colored area at the front of the eye. Uveitis may affect only the fluid that fills the eye, but may also affect the small blood vessels behind the retina. Symptoms of uveitis can include: redness in the eye, sensitivity to light, blurred vision, pain in the eye or "floaters" in the field-of-vision. Early detection and treatment is of the utmost importance. Untreated uveitis can cause irreversible damage to the delicate eye tissue, and it represents the third most common cause of preventable blindness in the nation.

When uveitis is localized at the front of the eye, it's called iritis. Iritis is an inflammation of the iris, a part of the eye. Symptoms include eye pain, sensitivity to light, and/or blurry vision and are often confused with the symptoms of conjunctivitis.

Keratitis is one of the more serious ocular conditions, which may occur in relation to ocular psoriasis. Keratitis is a term used to cover a range of ocular conditions where there is infection or inflammation of the cornea. Corneal involvement with ocular psoriasis is relatively rare. It usually occurs as a secondary infection related to eyelid or conjunctival complications, such as dryness, trichiasis, or exposure. This condition may result in severe eye pain, blurry vision, and sensitivity to light. Medical evaluation and treatment of keratitis is absolutely essential. Minor corneal infections are commonly treated with anti-bacterial or anti-fungal eye drops. If the problem is more severe, a person may receive more intensive antibiotic treatment to eliminate the infection and may even require steroid eye drops to reduce inflammation.