Psoriasis Linked to Increased Risk of Multiple Ocular Disorders

Patients with psoriasis face significantly increased risks for several ocular conditions, according to a new meta-analysis involving over 10 million individuals, published in AJO. The study found up to a fivefold increase in dry eye disease and elevated risks for cataract, uveitis, glaucoma and other eye disorders. The study authors emphasize the need for interdisciplinary care and routine ocular screening in this patient population. Photo: Cleveland Clinic. Click image to enlarge. The chronic autoimmune disease psoriasis can manifest as dry, itchy patches of skin, accompanied by joint pain. It’s been associated with systemic comorbidities such as arthritis, cardiovascular disease and metabolic syndrome. Growing evidence shows the disease may also play a role in ocular comorbidities as well, including uveitis and dry eye. A new study, published in American Journal of Ophthalmology, took a deeper dive into the literature, conducting a systematic review and meta-analysis to find an association between psoriasis and a variety of eye diseases. Their findings indicate these patients are at an increased risk for several ocular conditions.Researchers included observational studies from four major databases, including case-control, cross-sectional and cohort studies, with data on the risk estimates for cataract, uveitis, dry eye disease, glaucoma, retinal vein occlusion (RVO), conjunctivitis, meibomian gland dysfunction and blepharitis. A subgroup analysis was also performed on patients with psoriatic arthritis. Ultimately, this research effort comprised 34 studies involving 10,045,036 subjects from Asia, the Americas, Europe and Africa, with and without psoriasis.Patients with psoriasis showed an increased hazard ratio (HR) or odds ratio (OR) compared to individuals without the disease for each of the following:Cataract: HR=1.78Uveitis: HR=1.65Dry-eye disease: OR=5.01Glaucoma: HR=1.40RVO: HR=1.58Conjunctivitis: OR=3.76Meibomian gland dysfunction: OR=4.45Blepharitis: OR=2.28The subgroup analysis of those with psoriatic arthritis found an increased risk of incident uveitis among patients with psoriatic arthritis (HR=2.47), which was also found in patients with both mild and severe psoriasis (HR=1.13, HR=1.27, respectively). They also found substantially increased odds of dry eye disease (OR=18.73) in the subgroup.The authors cite several potential reasons for these associations., “First, psoriasis induces systemic inflammation, which can promote cataract formation,” they wrote in their AJO paper. Inflammatory mediators such as C-reactive protein, ICAM-1 and IL-6 have been involved in the pathogenesis of both psoriasis and cataract. Second, oxidative stress from psoriasis can destabilize the protein of the crystallin lens and excessive oxidation may cause glutathione loss in the nuclear region of the lens, accelerating the development of cataract. “Third, certain therapies for psoriasis have been associated with cataract,” they wrote, mentioning steroids as a risk factor of posterior subcapsular cataract in particular.Another potential link is the systemic inflammation found in both uveitis and psoriasis. Increased permeability of the blood-aqueous barrier may allow activated neutrophils to enter and induce uveitis, the researchers proposed. The shared mechanisms explain why certain therapies for psoriasis—for example, cyclosporine and TNF inhibitors—”are also effective in treating uveitis, which could prevent its development,” they wrote.Eight case-control and cross-sectional studies involving 1,078 subjects showed five times the odds of psoriasis patients developing dry eye disease. Potential reasons for this association include increased meibomian gland dysfunction, increased turnover of the epithelium and obstruction of the meibomian gland excretory duct, elevated levels of IL-17 in the tear film, increased β-defensin levels and decreased L-arginine levels. According to the researchers, this systematic review possesses good generalizability due to the inclusion of various ethnicities in the studies. One limitation to note was the heterogeneity of treatment status among psoriasis patients; not all were treatment-naive, and these medications could have decreased the incidence of uveitis, for example. Some included studies also lacked information on the severity, subtype and duration of psoriasis, and the outcome of eye diseases of different severities and types were not reported in most of the research. Additionally, the data relied on diagnostic codes of psoriasis and major eye diseases, which runs the risk of inaccuracy.The authors concluded by advising dermatologists to keep alert of ocular symptoms and signs in psoriasis patients, provide relevant patient education and be able to collaborate with eye doctors when needed “to provide prompt diagnosis and appropriate therapy for patients with ocular symptoms and signs to prevent irreversible sequelae.”Click here for the journal source. Wang, Ching-Ya et al. Ocular comorbidities of psoriasis: A systematic review and meta-analysis of observational studies. American Journal of Ophthalmology. September 18, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.