Psoriasis can significantly impact ocular health, leading to dry eye syndrome. Understanding its connection is essential for effective management and care.
Psoriasis (Dry Eye) refers to a situation where the chronic, inflammatory skin condition psoriasis extends its effects to the eyes resulting in a specific presentation of dry eye symptoms. Patients may experience a gritty, uncomfortable sensation along with redness and irritation that can compromise visual comfort. This condition emphasizes how psoriasis is not limited to the skin but can also affect other organs, including the eyes, highlighting the need for regular eye care.
Psoriasis is a chronic, immune-mediated skin disease characterized by rapid skin cell proliferation and the accumulation of thick, scaly, red patches. Although it is mostly known for its dermatologic manifestations, the inflammatory process behind psoriasis can also affect the eyes. Ocular involvement may stem from the direct impact on the meibomian glands, lacrimal glands, or the conjunctiva, the delicate tissue covering the white part of your eye, leading to conditions collectively known as dry eye syndrome.
When psoriasis involves the eyes, the condition is often more than just surface irritation. It may lead to a disruption in the normal tear film, an imbalance in the lipid layer, and even the loss of essential oil-secreting cells in the eyelids, which plays a crucial role in preventing the rapid evaporation of tears. Our eye doctors emphasize that timely recognition and management of these ocular issues are key to protecting your vision.
Dry eye syndrome, or keratoconjunctivitis sicca, is one of the most frequent ocular manifestations observed in patients with psoriasis. But what causes this dryness?
The inflammation associated with psoriasis can affect various parts of the ocular system, including the lacrimal gland responsible for tear production and the meibomian glands that secrete oils to keep tears from evaporating too quickly. In many psoriasis patients, studies have shown a significant loss of meibomian gland function—up to 15% more than in healthy individuals—and a thicker lipid layer in the tear film. This imbalance leads to the inadequate lubrication of the eye surface, resulting in the discomfort and visual disturbances patients often report.
These symptoms can vary in intensity and may flare up during exacerbations of the cutaneous psoriasis, especially during stressful periods, weather changes, or trauma.
If you're experiencing dry eye symptoms related to psoriasis, find a top optometrist near you for a comprehensive eye examination.
A crucial aspect of dry eye in psoriasis is the role played by the meibomian glands. These specialized glands, located along the eyelid margins, secrete oils that form a vital layer over the tear film. In psoriasis, the inflammatory process can disturb the normal function of these glands, leading to their dysfunction or even loss. This disruption contributes to a thinner or abnormally composed lipid layer, permitting excessive tear evaporation, which in turn precipitates a dry, uncomfortable ocular surface.
Objective measurements using devices like the IDRA® analyzer have shown that psoriasis patients often have a thicker than normal lipid layer paired with a significant loss of meibomian gland tissue. Despite these measurable changes, evidence suggests that, overall, patients with psoriasis may not have an increased risk of dry eye syndrome. However, the presence of dry eye symptoms in these patients remains a significant concern requiring further research.
Let’s explain the biological processes involved. Psoriasis is driven by an overactive immune response. Proinflammatory cytokines such as IL-17, IL-22, and TNF-alpha are released in excess, promoting inflammation not just in the skin but also in ocular tissues. This abnormal immune-mediated reaction can affect the epithelial cells lining the ocular surface and the ducts of the meibomian glands, leading to keratinization—an abnormal process in which cells become thickened and less effective at secreting oils.
Furthermore, this inflammation might reduce tear production by affecting the lacrimal glands. The interplay between these inflammatory molecules and glandular dysfunction results in an unstable tear film, characterized by a significantly reduced tear break-up time (TBUT) and lower Schirmer test scores. These changes are critical as they reflect the eye’s inability to maintain a stable and protective ocular surface, which is key for comfort and clear vision.
If you're experiencing dry eye symptoms related to psoriasis, find a top optometrist near you for a comprehensive eye examination.
Psoriasis extends beyond the skin; learn how it affects dry eye syndrome and the importance of ocular health.
