Ophthalmic Comorbidities in Patients with Chronic Plaque Psoriasis: A Hospital-Based Cross-Sectional Study of 100 Patients.

Purpose: To study the characteristics of ophthalmic comorbidities in patients with chronic plaque psoriasis.

Methods: We assessed the clinical and epidemiological attributes and characteristics of ophthalmic comorbidities of patients who had chronic plaque psoriasis for 15-25 years (mean ± standard deviation [SD], 3.9 ± 4.8 years). Out of 100 patients, 57 were males and 43 were females. In this cohort, the age range was from 19 to 77 years (mean ± SD, 41.8 ± 13.9 years). The severity of psoriasis was defined by the psoriasis area severity index (PASI) score as mild (PASI ≤6), moderate (PASI >6-12), or severe (PASI >12).

Results: Psoriasis was mild in 77, moderate in 13, and severe in 10 patients, respectively. Three patients had asymmetric oligoarthritis. In a cohort of 100 patients, there were 23 patients with moderate-to-severe psoriasis and 77 patients with mild psoriasis. In the moderate-to-severe psoriasis group, 18 out of the 23 patients also had ophthalmic abnormalities. In the mild psoriasis group, 53 of 77 patients also had ophthalmic abnormalities. Itching (n = 12; psoriasis was mild in 7, moderate-to-severe in 5 patients), decreased vision (n = 12; psoriasis was mild in 10, moderate-to-severe in 2 patients), redness (n = 9; psoriasis was mild in 5, moderate-to-severe in 5 patients;), watering/discharge (n = 8; psoriasis was mild in 6, moderate-to-severe in 2 patients), and pain or burning (n = 6; psoriasis was mild in 4, moderate-to-severe in 2 patients) were commonly complained by 31 patients. The major ophthalmic comorbidities in order of frequency observed were keratoconjunctivitis sicca/dry eye (n = 41), blepharitis (n = 29), meibomian gland dysfunction (MGD) (n = 18), conjunctivitis (n = 10), corneal abnormalities (n = 13), cataract (n = 14), retention cyst (n = 2), and anterior uveitis in 2 patients (without psoriatic arthritis). Common corneal abnormalities were punctuate keratitis (n = 7), corneal opacities (n = 4), band-shaped keratopathy (n = 1), and superficial vascularization (n = 1). Posterior segment manifestations of arteriosclerotic changes (n = 4), media haze (n = 2), and macular degeneration (n = 1) were likely to be age-related.

Conclusions: The ophthalmic comorbidities, such as blepharitis, MGD, conjunctivitis, keratoconjunctivitis sicca, corneal abnormalities, and presenile cataract, can occur in patients with psoriasis. These are largely asymptomatic and subtle findings that are often missed. They require an early consult to ophthalmology for appropriate management. The major limitations in this study are that it is a single-center, cross-sectional study design that has a low number of patients, lacks a healthy patient control group, and there is a lack of long-term follow-up.