Ocular manifestations of psoriasis

Cruz, Natasha Ferreira Santos da; Brandão, Larissa Silva; Cruz, Sérgio Ferreira Santos da; Cruz, Sérgio Augusto Sequeira da; Pires, Carla Andréa Avelar; Carneiro, Francisca Regina Oliveira

doi:10.5935/0004-2749.20180044

Brasil

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ORIGINAL ARTICLES • Arq. Bras. Oftalmol. 81 (3) • May-Jun 2018 • https://doi.org/10.5935/0004-2749.20180044 linkcopy

Ocular manifestations of psoriasis

Manifestações oculares observadas em pacientes com psoríase

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose: We aimed to report the ocular manifestations observed in patients with psoriasis.

Methods: Patients were included and referred to our ophthalmology clinic from dermatology clinics of Universidade do Estado do Pará between October 2013 and August 2014. Clinical interviews were conducted to identify relevant epidemiological data, clinical features, and treatment details, and data were recorded using the same protocol. Subsequent dermatological examinations were performed and disease severity was rated using the Psoriasis Area and Severity Index and the Dermatological Life Quality Index. Complete eye examination was conducted, including visual acuity, biomicroscopy, tonometry, fundoscopy, Schirmer I test, tear breakup time, rose bengal staining, ocular surface disease index, and glaucoma tests.

Results: In total, we included 43 patients with psoriasis and 86 controls. Patients with psoriasis had statistically higher incidences of dry eye (16.28%), likely dry eye (32.56%), and blepharitis (16.28%). Furthermore, the rose bengal and ocular surface disease tests were more abnormal in patients with psoriasis (p<0.05).

Conclusions: Patients with psoriasis should undergo regular eye exams, regardless of risk factors, to monitor for the progression of symptomatic or asymptomatic ocular manifestations.

Keywords: Psoriasis; Ocular manifestations

General information	Psoriasis (n=43)			Control (n=86)
General information	N	%		N	%
Gender
Female	21	48.84		46	53.49	0.7554
Male	22	51.16		40	46.51	0.7554
Arterial hypertension
Yes	12	27.91		19	22.09	0.6101
No	31	72.09		67	77.91	0.6101
Diabetes mellitus
Yes	07	16.28		05	05.81	0.1031
No	36	83.72		81	94.19	0.1031
Age (years)	Mean ± SD		Mean ± SD
Overall	47.88 ± 14.6112		47.47 ± 15.3621			0.8848
Female	47.86 ± 14.7793		46.22 ± 16.5877			0.5575
Male	47.91 ± 14.7967		48.90 ± 13.8893			0.7095

General characteristic of the disease	Quantily	Percentage	P-value
Clinical form			<0.0001*
Erythrodermic	1*	02.33
Large plaques	21*	48.84
Guttate	06*	13.95
Palmar-plantar	05*	11.63
Small plaques	10*	23.26
Psoriatic arthritis			0.3602
Yes	18*	41.86
No	25*	58.14
Nail psoriasis			0.7604
Yes	23*	53.49
No	20*	46.51
Psoriasis before or after age 40			0.2225
Before	26*	60.47
After	17*	39.53
Treatment for psoriasis (n=40)⁴			0.047*
Methotrexate	17*	42.50
Daivobet	13*	32.50
Etanercept	10*	25.00
Adalimumab	04*	10.00
No medication	03*	06.98
	Mean ± SD		0.4638
Duration of psoriasis	11 ± 8.8467
Female	12 ± 9.9824
Male	10 ± 7.6516
PASI (%)	6.22 ± 6.7580		0.7386
Female	5.86 ± 5.6148
Male	6.56 ± 7.8145
DLQI	5 ± 4.8217		<0.0404*
Female	7 ± 5.8064
Male	4 ± 2.7524

	Group
	Psoriasis		Control
	N	%	N	%	p-value
Ocular manifestations
Yes	35	081.40	52	060.47
No	08	018.60	34	039.53
Total	43	100.00	86	100.00	0.0284*
Most frequent ocular findings
Visual acuity £0.66	03	006.98	04	04.65	0.6850*
Cataracts	13	030.23	23	26.74	1.0000*
Pterygium	15	034.88	20	23.26	0.5221*
Pinguecula	06	013.95	17	19.77	0.0843*
Blepharitis	07	016.28	01	01.16	0.0037*
Conjunctival hyperemia	04	009.30	01	01.16	0.0629*
Keratitis	05	011.63	07	08.14	0.5327*
Dry eye	07	016.28	03	03.49	0.0302*
Probable dry eye	14	032.56	12	13.95	0.0085*
Glaucoma	01	002.33	01	01.16	1.0000*
Ocular pressure	12.8	± 2.3134	11.7	± 1.5893	0.0190*

Abnormal test	Group				p-value
	Psoriasis (n=43)		Control (n=86)
	N	%	N	%
OSDI	17	39.53	16	18.60	0.0246*
Dry eye	07	16.28	03	03.49	0.0302*
Probable dry eye	14	32.56	12	13.95	0.0317*
TBUT	23	53.49	35	40.70	0.2345*
Rose bengal	23	53.49	25	29.07	0.0120*
Schirmer	06	13.95	05	05.81	0.1784*

Variable	OSDI				p-value
	Mild/moderate (n=33)		Normal (n=96)
	N	%	N	%
TBUT
Abnormal	15	45.45	43	44.79	0.8912
Normal	18	54.55	53	55.21	0.8912
SCHIRMER
Abnormal	04	12.12	07	07.29	0.4706
Normal	29	87.88	89	92.71	0.4706
ROSE BENGAL
Abnormal	14	42.42	34	35.42	0.6103
Normal	19	57.58	62	64.58	0.6103

General characteristics		Ocular manifestations
General characteristics		Blepharitis	Keratitis
PASI
Mild	N	6	2
Mild	%	85.71	40.00
Moderate/severe	N	1	3
Moderate/severe	%	14.29	60.00
p-value		<0.0001*	0.0025*
Nail psoriasis
Yes	N	2	4
	%	28.57	80.00
No	N	5	1
	%	71.43	20.00
p-value		<0.0001*	0.0016*
Psoriatic arthritis
Yes	N	2	2
	%	28.57	40.00
No	N	5	3
	%	71.43	60.00
p-value		<0.0001*	0.0025*
After age 40 or not
After	N	3	2
	%	42.86	40.00
Before	N	4	3
	%	57.14	60.00
p-value		<0.0001*	0.0025*

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[TFN01] DLQI= the dermatological life quality index; PASI= psoriasis area and severity index.