Ocular Surface Manifestations Of Psoriasis : Findings From A Comprehensive Comparative Study

Psoriasis is a chronic systemic inflammatory disease with immune mediation and primarily cutaneous tropism, typically characterized by erythematous plaques and whitish scales on the extensor surfaces of the limbs. It is a common immunological condition of uncertain etiology that affects up to 5% of the general population. Besides its cutaneous symptoms, psoriasis can also be associated with various ophthalmological manifestations, often underdiagnosed and sometimes impacting the functional prognosis of patients.

The aim of our study was to highlight changes in the ocular surface among psoriasis patients to enhance their management .

Through a prospective comparative study conducted at the ophthalmology department of University Hospital HASSAN II in Fes over two years from November 2021 to November 2023, we included two groups of patients. The first group consisted of 32 patients diagnosed with and followed up for psoriasis by a dermatologist, while the second group comprised 32 control patients with no history of systemic or dermatological pathology.

All patients underwent a comprehensive ophthalmic examination, including assessment of objective clinical parameters of ocular surface (Eyelid examination, Schirmer test, Tear film breakup time measurement). They all also completed the Ocular Surface Disease Index (OSDI) questionnaire, which assesses subjective symptoms of dry eye syndrome, their severity, and their impact on the quality of life of patients with dry eye. We considered results statistically significant for a "p" value less than 0.05.

The mean age of patients in group 1 was 49.7 years, and in group 2 was 50.7 years, with a male predominance in both groups. In group 1, 40% of patients reported suffering from ocular surface manifestations, including 15 cases of dry eye, 10 cases of posterior blepharitis, and one case of keratoconjunctivitis, compared to 9% of patients in group 2. The Schirmer test showed a mean value of 10.8 mm in group 1 and 16.8 mm in group 2 (p<0.001). Tear film breakup time was 8.1 seconds in group 1 and 12.2 seconds in group 2 (p<0.001). The mean OSDI questionnaire score was 23 (indicative of moderate dry eye) in group 1 and 10.6 (indicative of a normal score) in group 2 (p=0.03).

Ocular surface disease in patients with psoriasis are unfortunately not rare, and dry eye is the most common manifestation of it. Therefore, it is important for dermatologists to act as sentinel physicians to actively screen for ocular manifestations in psoriatic patients and promptly refer them to ophthalmologists for early diagnosis and treatment.

Our study highlights the high prevalence of dry eye among patients with psoriasis, which should be taken into consideration before any corneal or cataract surgery. This underscores the importance of adequate management and personalized follow-up for these patients, both preoperatively, perioperatively, and postoperatively.