Psoriatic arthritis (PsA) mainly affects the skin and joints but can cause eye conditions and complications, including chronic dry eye, inflammation, glaucoma, and cataracts.

The National Psoriasis Foundation states that about 30% of individuals with psoriasis will develop psoriatic arthritis during their lifetime.

There are many ways in which PsA can affect the eyes, eyelids, and surrounding areas.

This article explains how PsA affects the eyes and how a person can treat and prevent these complications.

Infographic showing the effects of psoriatic arthritis on the eyesShare on Pinterest
Medical Illustration by Wenzdai Figueroa

One eye condition that people living with PsA may experience is chronic dry eye, or keratoconjunctivitis sicca. Experts believe that about 3% of people with PsA have this condition. However, some studies suggest that the number may be as high as 19%.

In a person with this condition, the tear ducts lose their ability to produce tears, which are vital for proper lubrication of the eyes. A lack of adequate lubrication increases the risk of eye infections and can damage the cornea.

In cases where over-the-counter artificial tears prove ineffective, prescription eye drops may help increase tear production and lower inflammation. For some people, steroid eye drops can offer short-term relief to control inflammation.

Uveitis is a type of eye inflammation that affects the middle layer of tissue within the eyeball, called the uvea. The symptoms of uveitis include redness in the white parts of the eyes, blurred vision, sensitivity to light, pain, and floaters.

There are four types of uveitis:

  • Anterior uveitis: This type involves the front of the eye and can cause inflammation of the iris.
  • Intermediate uveitis: This type occurs in the middle of the uvea and involves inflammation of the vitreous.
  • Posterior uveitis: Posterior uveitis involves the back of the uvea and can affect the retina.
  • Panuveitis: In people with this type, inflammation affects all parts of the eye.

Studies indicate that anterior uveitis occurs in 7-20% of PsA cases. However, a person with PsA may experience any of the above uveitis types.

The treatment for uveitis usually starts with corticosteroid eye drops to reduce inflammation. If these do not work, an eye doctor may recommend injecting the eye with a corticosteroid.

Cataracts result from cloudy films developing over the eye lens, leading to impaired vision. The Arthritis Foundation notes that inflammatory conditions such as PsA may advance the formation of cataracts.

Symptoms include:

  • cloudy vision
  • difficulty seeing colors
  • increased glare from artificial lights and sunlight
  • double vision
  • reduced night vision

People with cataracts require surgery to remove the cloudy lens and replace it with an artificial one.

Glaucoma is a group of eye disorders that damage the optic nerve. It can lead to vision loss.

Chronic inflammation from arthritic conditions, including PsA, can contribute to glaucoma by increasing the pressure in the eyes.

This eye condition has no symptoms in the early stages when it is the most treatable. However, an eye doctor may detect it when they are carrying out a regular eye examination, or it can occur as a complication of an inflammatory episode such as uveitis.

Symptoms that a person may experience include pain, blurred vision, and seeing blank spots or halos around lights. A doctor can prescribe eye drops to reduce the pressure in the eyes. Some people may require surgery.

Peripheral ulcerative keratitis (PUK) causes inflammation of the cornea, the transparent outer layer at the front of the eye. This inflammation makes the cornea prone to thinning. Peripheral ulcerative keratitis is more common in rheumatoid arthritis but can occur in PsA.

The symptoms of peripheral ulcerative keratitis include:

  • pain
  • redness
  • reduced vision
  • light sensitivity
  • tearing

Artificial tears and antibiotic drops can promote healing and prevent infection.

Scleritis is the inflammation of the white part of the eye, known as the sclera. The primary symptoms of scleritis are redness and tenderness or pain.

Arthritis can also cause episcleritis, which is inflammation of the episcleral tissue. This is a thin layer that covers the sclera.

Conjunctivitis is inflammation of the thin membrane on top of the sclera and inside the eyelids.

The main symptoms of conjunctivitis are:

  • eye redness
  • inflammation of the eye
  • discomfort and soreness
  • eye discharge
  • excess tear production

Rates of conjunctivitis in people with psoriasis and PsA are high.

Although it is rare, people may experience psoriatic lesions around their eyes.

Symptoms and flares

Flare-ups of psoriasis around the eye can cause:

  • skin discoloration
  • dry skin that may crack and bleed
  • eye dryness
  • pain when blinking or moving the eye

What to do

The skin around the eyes and the rest of the face is extremely sensitive. As a result, people must take the utmost care when dealing with flares.

Topical ointments are the first line of treatment, as with most psoriatic lesions. However, people must ensure they keep all lotions and creams out of the eyes or they may worsen the irritation and cause further complications.

If psoriasis around the eye is causing extreme discomfort or impacting their quality of life, a person should contact a medical professional immediately.

A person can mitigate the risk of developing PsA-related eye problems by reducing inflammation in the body.

Because PsA is an inflammatory condition, a doctor may prescribe medication to control inflammation within the body, improving eye conditions related to PsA.

When to see an eye doctor

Anyone with PsA should consider undergoing annual eye examinations and regular doctor visits to discuss any new or existing eye-related symptoms.

Some eye conditions do not have any signs in the beginning stages. Due to this, it is vital for people to get regular eye checkups to detect any problems as soon as possible.

Below are frequently asked questions about psoriatic arthritis and eye health.

Can psoriatic arthritis affect the eyes?

PsA can affect the eyes and the areas around them. While psoriasis is more common on elbow, knee, and hand joints, it can affect any part of the skin.

What are the symptoms of psoriatic arthritis in the eyes?

The most common symptoms of PsA in the eyes are discomfort and redness. People may also experience blurry vision and increased sensitivity to light.

What eye disease is associated with psoriatic arthritis?

Uveitis, conjunctivitis, keratitis, glaucoma, and scleritis can all occur with PsA.

Living with PsA can be challenging. In addition to the joint pain that PsA can cause, many people may develop eye problems.

The good news is that many PsA-related eye conditions are highly treatable.

Some conditions do not have early warning signs, so an eye examination is the best way to detect abnormalities. A doctor can help a person manage symptoms related to PsA and eye health.

Read this article in Spanish.