Did you know that having psoriasis or psoriatic arthritic (PsA) can affect your eyes leading to problems with vision? Even though this doesn't happen very often, for some of those living with psoriasis and psoriatic arthritis, problems with skin and joints are not the end of their story.
Psoriasis and psoriatic arthritis are both autoimmune chronic conditions that make the immune system attack its own cells leading to inflammation in several areas of the body like your scalp, chest, belly, elbow, knees, and joints but when this inflammation reaches the eye, it's called uveitis.
Read MoreCan Psoriasis Affect Your Eyes?
According to the National Psoriasis Foundation (NPF), about 7% of patients with psoriatic arthritis will develop eye problems (uveitis). Eye psoriasis is particularly challenging because the area around the eyes is very delicate and sensitive which requires extra care and monitoring by your doctor to avoid irritating or scaring the area.James Rosenbaum, M.D., a rheumatologist and ophthalmologist at Oregon Health and Science University shares his thoughts in an interview with NPF in 2019, about uveitis and its association with patients living with psoriasis saying "Why do you get uveitis with (psoriatic) arthritis together? That is a mystery just [like] getting skin disease and joint disease together".
Symptoms
Symptoms of psoriasis around the eye include the following:
- Discolored skin patches and scales around the eye
- Pain while moving eyelids
- Dry and cracked skin around the eye
- Bleeding of the skin around the eye
- Having difficulty opening and closing the eyes
- Itching and irritation around the eye
Other symptoms that happen when your eyes are inflamed from the inside (uveitis) include the following:
- Blurry vision
- Dry eyes
- Seeing lines and spots that are dark (known as floaters)
- Redness and inflammation
- Light sensitivity
- Burning sensation
- Small or irregular-shaped pupils
- Swollen eyelids
These symptoms can vary from person to person according to the severity of their condition and can also affect one or both eyes.
Therefore, Dr. Rebecca Haberman, M.D., a clinical instructor at New York University Grossman School of Medicine shares her advice with NPF saying "It is important to stay on top of an annual eye exam, especially for those with psoriasis because they are at a higher risk for developing psoriatic arthritis. The presence of mild inflammation could be an indication of the early stages of PsA development since uveitis is a strong risk factor for psoriatic arthritis"
Failing to treat these symptoms can lead to subsequent complications that can affect eyesight drastically like cataracts, conjunctivitis, and worst of all vision loss.
Risk Factors
Below is a list of risk factors that make you more susceptible to developing psoriasis of the eye. So, if you have any of these, you should consult your doctor on the best way to monitor you. These include the following:
- If you have been diagnosed with psoriasis in any area of your body
- If you have a family history of psoriasis, genetics play a role in getting this disease
- Being consistently stressed and anxious can impact your immune system and cause psoriasis
- Smoking puts you at risk of getting severe psoriasis
- Obesity also puts you at a higher risk of getting psoriasis (a type called inverse psoriasis)
Causes
Like psoriasis and psoriatic arthritis, the reason behind eye psoriasis is unknown, but it's believed to be a mix of genetic and environmental factors. That being said, the way to treat psoriasis and psoriasis-related conditions like psoriatic arthritis and eye psoriasis is to take medications that treat internal factors and avoid triggers from external factors of the environment.
Treatment
“We definitely are in a good era of treatment when it comes to psoriasis,” Dr. George Han, a dermatologist at Northwell Health/Lenox Hill Hospital, said in an interview with SurvivorNet. “But, overall, the majority of patients still get topicals first.”
When you have psoriasis of the eye, your doctor will have to deal with two things:
- Treating inflammatory symptoms of the eyes
- Treating your overall psoriasis and trying to reach a remission state where your symptoms are almost cleared up
Luckily, there are several treatment options for both conditions. But before initiating treatment, your doctor will take into consideration your overall health, medical history, and the type and severity of your psoriasis.
For inflammation of the eye (uveitis), your treatment options will be from the following:
- Eye drops (antibacterial, steroid, or lubricant)
- Topical medications (creams and ointments)
- Eyelash wipes or warm compresses (to remove scales from the eyelids)
- Systemic treatments
For psoriasis and psoriatic arthritis, your treatment options will be from the following:
- Topicals treatment
- Phototherapy or light therapy
- Corticosteroids
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Retinoids
- Coal Tar
- Vitamin D analogues
- Immunosuppressants
- Joint replacement therapy
- Disease-Modifying anti-rheumatic Drug (DMARD)
- Biologics
Dr. Haberman says "Getting an early start can help lead to more effective treatment. It is important to stay on your medications. Especially if you have recurrent uveitis, staying on your medications can reduce the risk of repeat episodes."
Home Remedies
Aside from following the treatment strategy recommended to you by your doctor, you can also incorporate some lifestyle changes and home remedies that can help with relieving your symptoms. These include the following:
- Applying cool water to soothe the eyes
- Using gentle cleaning products devoid of chemicals
- Avoiding hot water
- Quit smoking and drinking alcohol
- Maintain a healthy weight
Tips
In order to maintain a state of remission where your symptoms are almost cleared up and you no longer experience flare-ups and discomfort, you can practice avoiding some triggers that can affect your eyes and aggravate psoriasis symptoms. These may be routine activities that you perform every day without noticing their effect, take a look at some of the most common triggers affecting the eyes:
- Putting make-up on (this can interfere with your topical medications and sometimes irritate the skin even more. Talk to your doctor about options to cover your patches without triggering your symptoms).
- Piercings in the eyebrows or around the eye (this can cause trauma and injury to the skin which eventually leads to triggering psoriasis symptoms. The same goes for getting tattoos around this area).
- Wearing contact lenses (you should consult your doctor first about the best brand for you. Using the wrong brand of lenses or solution can irritate and inflame your eyes.
This list doesn't cover all the triggers to psoriasis of the eye. Additionally, this can be different from one person to another. So, you should investigate your own triggers and try to avoid them to maintain a prolonged remission time.
Questions to Ask Your Doctor
- How can I avoid getting uveitis?
- What are my treatment options?
- What's the best treatment you recommend for me?
- What are the risks and benefits of your recommended treatment?
- What can I do to avoid getting flare-ups?
- How often should I have my eye tested?
- Is there anything I should do to improve my quality of life?
- What happens if I stop responding to treatment?
The Bottom Line
Even though psoriasis and psoriatic arthritis generally involve symptoms of the skin and joints, they can affect your eyes leading to vision problems. If you're experiencing any trouble with your eyes, you should contact your doctor immediately so that they can best assess your condition and prescribe the right treatment for you before any unwanted complications ensue.
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