Are My Eye Problems Related to My Psoriasis?

If your eyes feel dry or irritated, it might be related to your psoriasis. But don’t worry — there are ways to manage any eye issues and keep your vision clear.

Plaque psoriasis (PsO) is mostly known to affect the skin on your elbows, knees, and scalp. But it can also lead to changes around your eyes.

In fact, researchers have found that 10% to 12% of people living with PsO may have eye-related symptoms. Yet, these symptoms are often overlooked and can lead to visual impairment if not treated early and properly.

To help you figure out if you’re experiencing eye changes related to psoriasis, here’s a rundown of the common symptoms and conditions that can happen.

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Keratoconjunctivitis sicca

Keratoconjunctivitis sicca — also known as dry eye syndrome — affects an estimated 18.75% of people with PsO.

Dry eye syndrome often happens in people with PsO because the tiny glands in their eyelids, called meibomian glands, don’t work properly. This can block the ducts in these glands, leading to dry and irritated eyes.

This condition can also be linked to problems with the tear film (the thin layer of tears that covers your eyes). People living with PsO might have lower levels of a substance called L-arginine, which can lead to these issues.

If you’re experiencing keratoconjunctivitis sicca, you may have:

• very dry eyes
• a sensation like there’s something in your eyes
• blurry vision
• light sensitivity

These symptoms may get worse throughout your day.

Managing your PsO is important for treating this eye condition, but there are also many other environmental changes and treatment options that can help.

Changes to your environment

• Avoid fans or direct airflow.
• Reduce screen time and take frequent screen breaks.
• Use a humidifier.

Over-the-counter medications and other treatments

• topical ocular lubricants (eye drops)
• warm compresses, baby shampoo, and approved lid scrubs for lid hygiene
• fatty acid supplementation (oral)
• identifying potential triggers

Alternative treatment options

• night-time ointment or moisture goggles for sleep
• device-assisted heat treatment for the meibomian glands
• Intense Pulsed Light (IPL) therapy
• topical anti-inflammatory medications
• therapeutic contact lenses
• surgery

Blepharitis

Blepharitis happens when your eyelid margins (the edges of your eyelids) become inflamed. This can also lead to crusting and flaking of the skin in the same area, and loss of eyelashes.

Prevention usually involves warm compresses, eyelid hygeine, and when related to psoriasis, good control of the skin condition itself.

Treatment usually involves more frequent eyelid hygeine with warm water and baby shampoo, antibiotics, and topical steroids.

Other treatment options might include:

• tea tree oil (formulated specifically for the eyes)
• the LipiFlow device for thermal pulsation therapy
• MiBoFlo thermal therapy
• BlephEx to remove debris
• a Maskin probe to help promote healthy oil secretions

Conjunctivitis

Conjunctivitis is an infection of the conjunctiva that can be both contagious and not contagious. The conjunctiva is a thin layer of cells covering the surface of the eyelids and whites of the eyes.

Some research has shown a prevalence rate of as high as 64.5% in people living with psoriasis.

Conjunctivitis is an eye condition that can be caused by PsO, but it’s more commonly due to allergies, bacterial infections, or viral infections.

Symptoms include:

• redness
• tearing
• thick, rope-like discharge, which is usually yellow to green in color

If left untreated, it can lead to more serious eye complications.

Treatment will depend on the type of conjunctivitis. A healthcare professional will determine the right treatments based on your symptoms and the cause, but it might include rinses, antibiotics, warm compresses, or allergy medications.

Uveitis

Uveitis is an inflammatory disorder of the mid-portion of the eye. Although it’s relatively rare, it’s a serious complication of psoriasis.

Data is limited, but it’s estimated that about 7% to 20% of people with PsO develop uveitis. The rates are higher in people diagnosed with psoriatic arthritis.

PsO-related uveitis is usually bilateral (affecting both eyes), chronic, and severe. Both psoriasis and uveitis are strongly tied to immune system function, and because of this, can usually be treated with the same targeted biologic therapies.

If undiagnosed, or diagnosed very late, PsO-related uveitis can cause worsening symptoms overall and even loss of vision.

Keratitis

Keratitis, or keratopathy, happens when harmful cells enter the layers of the cornea (the clear front part of your eye). This can be caused by something like an infection, a foreign substance, or even your own immune system attacking the eye by mistake.

Keratitis can lead to serious damage, causing ulcers on the cornea and potentially leading to low vision or even blindness.

In people with psoriasis, keratitis is usually caused by the immune system and is not due to an infection. Diagnosing it can be tricky since it often requires seeing a specialist and doing lab tests.

Treatment usually involves topical and oral steroids as well as methotrexate.

If the cornea is already damaged or has a hole, doctors might use special treatments to fix it. These treatments can include:

• Amniotic membrane graft: In this procedure, layers of tissue from a donated amniotic membrane (part of the placenta) are grafted to help heal the cornea.
• Corneal patch graft: This graft procedure comes from a small piece of cornea from a donor. It will cover the damaged area.

UV-induced cataracts

If you’re living with PsO, you may have used some sort of ultraviolet (UV) light treatments to manage your plaques and get clearer skin.

In some cases, this can lead to a type of cataract where UV light changes the proteins in the lens of your eye.

This could cause:

• vision loss
• difficulty seeing at night due to glare from lights
• reduced ability to see differences in contrast

Your eye doctor may notice that the lens of your eye looks cloudy during an exam.

Another type of cataract, called a posterior subcapsular cataract, can develop from long-term use of corticosteroids, a class of medication often used to treat psoriasis.

While cataracts aren’t directly caused by psoriasis, they can result from the treatments used to manage the condition.

Birdshot chorioretinitis

Birdshot chorioretinitis is an unusual and rare cause of ocular inflammation. Due to its rarity, there’s little data available.

Some reports state that birdshot chorioretinitis accounts for 0.5% to 1.5% of uveitis cases seen by specialists in uveitis practices.

Recent research shows that this is due to a genetic mutation involving a specific enzyme, which has also been recognized in PsO.

Early symptoms include:

• floaters
• blurred vision
• decreased vision

Later symptoms when the condition has progressed include:

• night blindness
• diminished contrast sensitivity
• decreased color vision

Treatment usually involves steroids, either taken as pills or given directly into the eye through injections or implants. These steroids help reduce inflammation but can also increase the pressure inside the eye, which, if not carefully monitored, could lead to permanent vision loss.

To avoid using too many steroids, doctors might also use other medications called steroid-sparing immunomodulatory therapies. However, these medicines can have a lot of side effects, so it’s important to talk about them thoroughly with your eye doctor.

There isn’t one treatment plan that works for everyone, and often combination trials are necessary. These treatments may also involve teams of specialists for close monitoring and potential adjustments.

In some cases, with proper and early treatment, visual acuity can improve by 78.6% to 89.3%.

Other potential eye symptoms

Psoriasis skin plaques may also affect your periorbital area, or the skin around the eye. Treating this can be challenging, as many medications have limitations when it comes to safe application on the face, particularly around the eyes.

Of all eye problems discussed, the most common are dry eye syndrome, blepharitis, conjunctivitis, and uveitis.

It’s not entirely clear if the treatments for PsO may affect eye health overall, either. Eye problems may also be a side effect of some PsO treatments, like methotrexate, acitretin, and some biologics.

Bottom line

If you’re having new or worsened eye complaints, be sure to talk with a healthcare professional about your current treatment plan.

The best way to prevent and manage eye problems related to psoriasis is to consistently attend your follow-up appointments and take your medications as prescribed.

This helps keep your psoriasis managed and reduces the risk of complications affecting your eyes.