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Psoriasis & the Eyes

Eye Health
By Dr S.S. Gill
Ipoh Echo’s EYE HEALTH series continues with Consultant Eye Surgeon Dr S.S. GILL talking to us about EYE PROBLEMS related to PSORIASIS.
PSORIASIS is a skin condition that is common resulting in the skin cells rapidly proliferating on the skin surface. So what’s so special about this skin condition? Well, for a start, psoriasis is an autoimmune disease. This actually means that the body’s own immune system can attack various organs including the eyes, to cause troublesome problems. Patients with psoriasis also have a higher risk of heart attacks and joint inflammation (psoriatic arthritis).
 
WHAT HAPPENS IN PSORIASIS
Firstly, in psoriasis the immune system in the body overreacts resulting in too rapid a skin cell proliferation that accumulates on the skin surface. This accumulated skin eventually forms thick scaly skin patches that may become itchy, red and dry.
Psoriasis may affect the eyes in two ways, i.e., either LOCALLY if it affects the eyelid skin or as a GENERALISED autoimmune problem that simultaneously affects the deeper tissues of the eyes.
 
EYE PROBLEMS DUE TO FACIAL SKIN or EYELID PSORIASIS
Psoriasis may affect the facial skin or even the skin of the eyelids. This can pose local problems to the eyes as follows:
The eyelids become scaly and these scales may flake off to enter the eye causing local irritation, redness, eye itchiness and secondary infection.
Eyelid margins may become inflamed and painful.
Eyelid margins may become distorted due to chronic inflammation and thus alter the tear film to worsen a dry eye condition.
 
EYE PROBLEMS DUE TO THE AUTOIMMUNE ASPECT OF PSORIASIS
This is the more serious complication of psoriasis because of the autoimmune aspect related to it. When we say autoimmune, it means that the immune system of our bodies begins to attack its’ own normal tissues which in this case are the eyes! The eye inflammation causes:
a. UVEITIS: Inflammation of the uveal tissue (brown/pigmented part) in the eye
b. Keratoconjunctivitis Sicca: Dry Eyes & Conjunctival (clear part of eye) inflammation
c. Scleritis: Inflammation of the white of the eye.
d. Glaucoma: High eye pressure resulting that can cause blindness if uncontrolled.
 
a) UVEITIS
This is the inflammation of the brown or pigmented part of the eye. The eye becomes red, painful, sensitive to light (photophobia), with tearing and blurring vision to a lesser or greater extent. The condition will need to be checked by an eye doctor as uveitis can only be diagnosed using special eye examination equipment. The uveitis will need to be treated correctly as it can lead to permanent loss of vision!
 
b) DRY EYE SYNDROME (Keratoconjunctivitis Sicca)
Dryness affects a fair number of people with Psoriasis. The conjunctiva (the clear part of the eye covering the white part of the eye) becomes inflamed. The eyes’ tear glands become affected and do not produce enough tears. Hence the patient suffers from symptoms of dry eyes like grittiness, itchiness, burning sensation and reflex tearing.

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