From everydayhealth.com
How to keep the skin condition from negatively impacting your vision
If you have psoriasis, the same inflammation that causes the dry, scaly patches on your skin can also spread to your eyes, which can not only be uncomfortable but may impact your vision.
About 10 percent of people with psoriasis will experience some problems with their eyes, says Galen Foulke, MD, a dermatologist and assistant professor at the UNC School of Medicine in Chapel Hill, North Carolina. Some eye problems include uveitis, blepharitis, conjunctivitis, and iritis, according to the National Psoriasis Foundation (NPF).
One reason the problem isn’t more widespread is because “The areas of your body that get a lot of sunlight exposure tend not to have psoriasis on them, and that includes your face and eyes,” Dr. Foulke notes.
However, when a psoriasis flare does strike the eyes, it can impact a lot of different parts of the eye, including the eyelids, the lashes, the oil glands in the eyelids, the surface of the eye, and even some of the internal parts of the eye, he adds. These problems, if left untreated, can cause permanent damage and vision loss.
Here’s what you need to know to keep your eyes healthy with psoriasis:
Psoriasis Flares and the Eyes
Psoriasis flares can affect the eyes intermittently, and the effects could become chronic if they are left untreated, Foulke says. That’s why it’s important to take your psoriasis medications as prescribed to reduce the number of flares you experience, and to stay connected with your dermatologist or ophthalmologist, he adds.
“They can help manage any flares that do occur in the area around the eyes,” Foulke notes.
Outside of basic hygiene practices, Foulke doesn’t typically recommend that people with psoriasis do anything special to care for their eyes.
“However, when you have psoriasis it’s important to know what to look for, and if you notice psoriasis encroaching on your eye, bring it to your doctor’s attention,” he says.
Although relatively rare, psoriasis flares in or near the eyes can be painful and hard to treat, according to the NPF.
Scales and dryness on the skin of the eyelids may cause them to curve up or down, which may lead to drying of the cornea (the clear layer on the front of the eye) or enable your eyelashes to scratch the surface of the cornea, damaging it and, potentially, your vision.
To avoid these complications, the NPF recommends:
- Washing the eyelids and lashes with a mixture of water and baby shampoo.
- Using an over-the-counter eyelid cleaner to remove scales.
- Applying a prescription topical medication, such as pimecrolimus or tacrolimus, around the eyes.
If your eye flares don’t respond to these self-care steps, you may need to see an ophthalmologist, who may prescribe steroid eyedrops to treat your inflammatory eye condition, says Peter Y. Chang, MD, an ophthalmologist who specializes in ocular inflammatory disease at the Massachusetts Eye Research & Surgery Institution in Waltham, Massachusetts.
“If it’s just one or two episodes, and the inflammation responds to steroids, that’s how we would treat the flare-up,” he explains. “While steroid eye drops are fine to use on a flare-up that occurs every few years, if the inflammation becomes very chronic — it keeps coming back — we don’t want to keep using steroids on the eye.”
Overuse of steroid eyedrops can cause cataracts to form. Cataracts are a clouding in the lens of the eye that leads to vision loss. The drugs can also cause an increase in eye pressure, which could in turn cause glaucoma, according to Dr. Chang.
“In most cases, we would use a systemic therapy, similar to what a dermatologist might do if someone had psoriatic arthritis or if their psoriatic lesions covered a lot of the body,” he says. That could include an immunosuppressant, immunomodulator, or a biologic, he adds.
Common Eye Conditions in People With Psoriasis
Psoriasis may put you at higher risk for potentially serious eye conditions such as uveitis and iritis, particularly if you also have psoriatic arthritis or lupus, the NPF says. Both are caused by inflammation, the underlying problem behind psoriasis.
Uveitis is inflammation of the uvea, the pigmented central layer of the eye between the inner retina and the outer layer of the eye composed of the sclera and cornea, according to the American Academy of Opthalmology (AAO). When uveitis occurs in the front of the eye, near the iris, it’s called iritis, or anterior uveitis.
If left untreated, uveitis causes irreversible damage to the eyes, which can lead to vision loss or even blindness.
The symptoms of uveitis are:
- Eye redness
- Light sensitivity
- Blurry vision
- "Floaters," or small specks or spots, in your field of vision
- Eye pain
If you experience any of these symptoms, you should be examined by an ophthalmologist, an eyecare specialist with expertise in diagnosing and treating medical problems involving the eyes, Chang says.
However, because uveitis and iritis would likely be related to your psoriasis, the ophthalmologist may consult with your primary care doctor, rheumatologist, and/or dermatologist to develop a treatment plan. In most cases, prescription corticosteroid eyedrops are the first-choice treatment for these conditions. These drugs, which you can administer yourself, should clear any inflammation.
Still, if uveitis and iritis recur, or become chronic, you may need an immunosuppressant drug. These drugs are designed to suppress an overactive immune system, which is causing the inflammation behind psoriasis and other eye problems.
People with psoriasis are at higher risk for recurrent uveitis, according to the NPF. Some types of psoriasis are also linked to an increased risk of developing certain inflammatory eye conditions, according to Foulke. For example, conjunctivitis, or inflammation of the eyelid or conjunctiva, is more common in people with severe psoriasis, he says.
“People with psoriasis who also have inflammatory arthritis, or psoriatic arthritis, are at a much higher risk for uveitis,” he says.
Another less common eye condition associated with psoriasis or psoriatic arthritis is scleritis. Scleritis is caused by inflammation in the white part of the eye, which is called the sclera, Chang says.
A more severe form of the condition, episcleritis, affects both the episcleral tissue between the conjunctiva and the sclera, he adds.
Symptoms of scleritis, according to the AAO, include:
- Severe pain or tenderness in the eye
- Blurry vision
- Heavy tearing
- Severe light sensitivity
Finally, people with psoriasis may also be at increased risk for conjunctivitis, or pink eye, which is also caused by inflammation. Conjunctivitis causes redness in the conjunctiva, the transparent membrane that lines your eyelid and covers the white part of the eye, the AAO says.
Common symptoms of conjunctivitis are:
- Redness and/or itchiness in one or both eyes
- A gritty sensation in one or both eyes
- A discharge in one or both eyes
- Heavy tearing
The hallmark or most obvious symptom is having a dry or consistently gritty sensation in the eyes, as if there were sand in the eye, Foulke says.
“This needs to be investigated to make sure that their conjunctiva — that’s the outer protective layer of the eye — is doing well,” he says. “If I notice that a patient’s eyes are extremely red during their skin exam, I send them to an ophthalmologist. Although everyone has some red blood vessels in the whites of their eyes, if there are lot of angry-looking blood vessels, that should be checked out.”
Your Dermatologist Can Help Treat Eye Problems Related to Psoriasis
In some cases, less common and less severe eye health complications associated with psoriasis can be treated by your dermatologist or rheumatologist, according to Foulke.
“The milder types of psoriasis that impact the eye involve the eyelid, eye lashes, or the oil glands” near the eye, he says.
Inflammation of the eyelids is called blepharitis. The eyelids become red, irritated, and itchy, and dandruff-like scales typically form on the eyelashes, according to the American Optometric Association.
Most of the time this type of inflammation can be treated by your dermatologist, meaning you don’t have to make a separate appointment with an eyecare professional. To treat blepharitis, your dermatologist may recommend certain topical creams or lotions, warm-water soaks, or baby shampoo compresses, Foulke explains.
“There are lots of topical options to safely treat the area around the eyes, such as weak topical steroids that are specifically chosen to treat areas around the eye,” he adds.
There’s also a class of treatments called topical calcineurin inhibitors (TCIs). “These topical ointments can be used around the eye without concern — we even sometimes put them directly in the eye to treat inflammatory conditions of the eye,” Foulke notes.
Keeping Your Eyes Healthy When You Have Psoriasis
Although most eye problems related to psoriasis can’t be resolved without medical treatment, there are steps you can take to lower your risk for them. For example, stress management is important in keeping your eyes healthy, according to Chang.
“Stress is a really big inducer of psoriasis flares, whether that’s psychological or physical stress,” he says. “When patients are stressed out and not sleeping, flares can occur.”
Smoking can also damage the eyes and increase your risk for eye problems, the AAO notes. Conversely, stopping smoking can reduce the risk of some eye conditions, Chang says.
In addition, eating a balanced and healthy diet is good for overall health, including eye health, even though there’s no definitive study that shows a particular diet helps control psoriasis flares, according to Chang.
“I’ve had patients try gluten-free diets or cut out dairy or refined sugar,” he says. “In some cases, it might make a difference in that person, but there’s no one way that will help everyone.”
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