Psoriatic Arthritis and Eye Problems
Reviewed by: HU Medical Review Board | Last reviewed: October 2016. | Last updated: March 2020
Several autoimmune diseases affecting the eyes have been observed in PsA patients, including uveitis, keratitis, blepharitis, conjunctivitis, episcleritis, and scleritis. The most common ophthalmic disease in PsA patients is uveitis. People with PsA are at a slightly higher risk of developing uveitis than the average person. According to clinical studies, approximately 7% of patients with PsA will develop uveitis, and one study found that as many as 17% of children with PsA will develop uveitis.1,2
What is uveitis?
Uveitis is a term that describes a group of inflammatory diseases in the eye that lead to swelling and destroy eye tissue. The effect of uveitis can range from slightly reduced vision to severe vision loss. The term uveitis refers to inflammation of the uvea, which is the middle layer of the eye that provides the majority of the blood supply to the retina, but uveitis can also affect the other structures in the eye, including the lens, retina, optic nerve, and vitreous. Uveitis can occur at any age but it is most often seen in people between the ages of 20 and 60 years.2,3
What are symptoms of uveitis?
Uveitis can affect one or both eyes, and symptoms often develop rapidly. However, in some patients, the symptoms can occur more gradually. Several other autoimmune disorders, such as rheumatoid arthritis and lupus, are also known to cause an increased risk for developing uveitis.2,4
Symptoms of uveitis include:
- Blurry vision
- Dark, floating spots in the vision (floaters)
- Eye pain
- Redness of the eye
- Sensitivity to light (photophobia)3,4
Uveitis can cause permanent vision damage, even with treatment. Additional complications may include cataracts, fluid within the retina, glaucoma, retinal detachment, and vision loss or blindness. Early treatment is important to reduce the risk of complications, and patients with eye pain, severe light sensitivity, or any change in vision should immediately see an ophthalmologist for examination. 3,4
How is uveitis diagnosed?
Uveitis is detected through an eye examination and generally includes:
- Visual acuity test, using an eye chart to test vision
- Funduscopic exam, in which the pupil is dilated with eye drops to allow the doctor to use an ophthalmoscope to view the inside of the eye
- Ocular pressure, using an instrument such as a tonometer or a tonopen to measure the pressure inside the eye
- Slit Lamp Exam, in which a dye may be added to the eye to allow the doctor to view the blood vessels in the eye3
Reducing the risk of uveitis
Early and aggressive treatment of PsA reduces the risk of long-term complications, such as uveitis. In addition, treatment for PsA can slow or prevent potential joint damage, deformity, and loss of function. Early treatment of uveitis is also critical to eliminate inflammation, alleviate pain, prevent further tissue damage, and potentially restore any loss of vision. While systemic treatments for PsA that reduce inflammation will help in reducing the inflammation of uveitis, specific treatment for the eyes is usually required. Treatment for uveitis includes steroidal anti-inflammatory medication that may be taken as eye drops, pills, injections around or into the eye, intravenous (IV) administration or a capsule that is surgically implanted inside the eye.2,3,5