Psoriatic Arthritis and Eye Problems: What’s the Link?

People with PsA have a higher risk of developing certain eye symptoms, like redness, eye pain, and vision impairment. Uveitis is one of the most serious but less common.

If you’re experiencing eye inflammation and you also have psoriatic arthritis, you may be wondering if the two are connected.

The inflammation that happens in your body from PsA doesn’t just happen in the affected joints or skin — it affects your whole body.

This systemic inflammation may be responsible for eye issues in psoriasis and PsA that can have potentially serious outcomes if left untreated.

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Can PsA affect your eyes, and what are the symptoms to watch out for?

Many people with PsA don’t just have joint and skin symptoms. They also experience eye changes, often including eye redness, pain, swelling, or changes in vision. Symptoms can happen to one of both eyes.

You might confuse these for seasonal allergies, but if you have PsA, they may be related to your condition — especially if you notice them at the same time as your PsA flares.

Eye conditions linked to PsA

You may have a higher risk of developing several eye conditions if you have PsA.

Dry eyes

Keratoconjunctivitis sicca — commonly called dry eye syndrome — is the most common eye condition that can happen with psoriasis.

It happens in 18.75% of people with psoriasis. Dry eye syndrome occurs when one type of gland becomes blocked. These glands produce the tear film that protects your eyes.

You can still produce tears, but their composition is different and they evaporate faster than usual, leading to a feeling of dryness.

Symptoms include:

• dry eyes
• a feeling that there’s something in your eye
• blurred vision
• sensitivity to bright light

It can get worse throughout the day.

Cataracts

If your vision is starting to get cloudy or blurry, colors appear faded, and you can’t see as well at night, you may have a cataract.

If you have PsA, you have an increased risk of inflammation in the eye that can cause cataracts. Corticosteroid use or infections are other possible contributing factors.

People often treat cataracts with surgery that replaces the cloudy lens of the eye with an artificial lens.

Conjunctivitis (aka pink eye)

Pink eye is inflammation of the conjunctiva, a membrane that covers the whites of your eyes as well as the insides of your eyelids.

Conjunctivitis commonly occurs due to an infection, but it’s also a common eye condition associated with psoriasis.

Symptoms include:

• redness (medically known as hyperemia)
• yellow-red lesions in the whites of the eye
• eye dryness
• a feeling of grittiness in the eye
• pain in the eye

If you’re having these symptoms, see an ophthalmologist for evaluation. They can rule out infections or other causes.

Scleritis

Scleritis happens when the whites of your eyes — called the sclera — become inflamed. It’s not often a serious condition.

It can look a lot like conjunctivitis, but the swelling is happening in the tissue of the sclera rather than in the conjunctiva that covers it.

Symptoms can include:

• redness that doesn’t go away even when you use eye drops to reduce inflammation
• light sensitivity
• deep pain

Corticosteroid eye drops can help, but sometimes scleritis requires systemic control of inflammation.

Experts say this condition can be a sign that inflammation is high in your body in general.

For this reason, keeping your whole-body inflammation managed can help, like with anti-inflammatory lifestyle changes and medication.

Blepharitis (eyelid inflammation)

This is another common eye condition in people with psoriatic arthritis. Symptoms include:

• redness of the upper and lower eyelids
• swelling
• mild scaling
• sensations of itching and burning

If you have blepharitis, home treatments include applying a warm compress and washing the eyelashes and eyelids regularly with a gentle cleanser.

Your doctor may also recommend applying topical corticosteroids to your eyelids.

Uveitis

Uveitis is when the uvea (the middle layer of the eye) becomes inflamed. It’s one of the most serious eye conditions associated with PsA, though it’s less common.

Symptoms of uveitis can include:

• blurry vision
• eye pain
• redness
• sensitivity to light
• dark spots that seem to float in your field of vision, sometimes called “floaters”

If you don’t treat uveitis, it can lead to vision loss, so it’s important to speak with an ophthalmologist if you think you might have it.

Treatment can make uveitis go away. Ustekinumab (Stelara) is one anti-inflammatory medication known to help with this condition.

Glaucoma

If you’re feeling symptoms like pain in your eye, blurred vision, blind spots, or a rainbow halo effect when you look at lights, you may be experiencing glaucoma.

There are several causes of glaucoma. Inflammation in the eye causing pressure to build up is often the cause. It may also be caused by infection.

If you have glaucoma, your ophthalmologist may recommend you use one or a combination of eye drops to reduce the inflammation. If those don’t work, surgery may be an option to reduce the pressure.

It’s important to note that corticosteroid therapy for PsA can be a possible cause of glaucoma. If this is the case, your doctor will likely try to work with you to reduce your corticosteroid use.

The condition doesn’t always have symptoms in its early stages, so it’s a good idea to get eye exams regularly.

Peripheral ulcerative keratitis (PUK)

This condition occurs when the limbal region of your eye becomes damaged by inflammation that appears in a characteristic crescent shape.

The limbal ring is the circle around your iris that separates it from the white of your eye, called the sclera.

PUK is most common in people with rheumatoid arthritis (RA), but it can also happen in people with PsA and other systemic inflammatory conditions.

Topical treatments like corticosteroids don’t tend to work well for PUK on their own. Systemic anti-inflammatory medications are more effective, and surgical options may also be available.

Ocular migraine

An ocular migraine is a type of migraine condition that causes you to lose vision in one eye for a limited period (usually less than an hour). It can start as a small blind spot in the center of your visual field and expand from there.

In an ocular migraine, blood flow is reduced, or blood vessels may spasm behind the eye or in the retina.

Ocular migraine is not technically an eye condition, though symptoms are related to the eyes. It’s a neurological condition associated with the activity of nerve fibers in your brain’s blood vessels.

Research has found that people with psoriasis have a greater likelihood of having migraine with aura compared with people who do not have psoriasis. However, we could find no research exploring ocular migraine and PsA specifically.

Migraine with aura may also involve eye symptoms, such as temporary flashes of light, blind spots, or vision loss.

If you experience ocular migraine or any eye symptoms accompanied by migraine, it’s important to get an eye exam.

If you haven’t been diagnosed with migraine before, your doctor may request neurological testing, blood tests, or imaging tests to rule out other conditions that can cause temporary loss of vision.

PsA symptoms around the eyes

According to the National Psoriasis Foundation, half of all people with psoriasis have flares on their face — but psoriasis around the eyes is very rare.

When it does occur, psoriasis around the eyes can cause the following:

• dryness
• redness
• discoloration
• discomfort
• impaired vision

In addition, psoriasis that affects the eyelids or eyelashes may be scaly, red, and crusty.

Only use topical medications like corticosteroids around your eyes if you’re told to by a healthcare professional. Overusing them can lead to certain eye conditions, such as glaucoma, infections, and cataracts.

Other treatment options for psoriasis around the eyes include light therapy and oral medications.

Managing symptoms

Treating eye symptoms related to PsA will depend on the condition and symptom.

In many cases, eye inflammation is linked to inflammation in your skin or joints, so treating systemic inflammation can be effective.

If you’re already taking medication like methotrexate for your PsA but you’re experiencing eye issues like uveitis, speak with your doctor. They may want to increase or change your dose.

Topical corticosteroids are effective in treating some eye conditions but can be harmful in others. Avoid taking topical treatments for your eye condition unless a doctor recommends it.

When to see an eye doctor

If you’re experiencing eye issues, like redness, pain, or vision problems, it’s best to see a doctor or ophthalmologist right away.

Even when you’re not having eye problems, getting regular eye exams can also be helpful because they can help detect eye issues early, even if you’re not having symptoms — like with glaucoma.

Takeaway

You might think of psoriatic arthritis as a joint and skin condition, but eye issues can also be part of the package.

There are many treatments out there that can help with PsA and your eye symptoms.