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Ellen Kay, Robert John Barry, Gibran Butt; The presentation of patients with psoriasis to opthalmology accident and emergency. Invest. Ophthalmol. Vis. Sci. 2018;59(9):160.
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© ARVO (1962-2015); The Authors (2016-present)
Psoriasis affects 3% of the population, with associated ocular manifestations in 10% of patients. Ocular involvement is usually observed in the form of potentially sight-threatening uveitis and blepharokeratoconjunctivitis. Screening for inflammatory eye disease is therefore recommended for all patients to enable early diagnosis and treatment, and to prevent irreversible damage to ocular tissues.
Retrospective analysis of psoriatic patients presenting to the emergency department of a large tertiary referral eye hospital in Birmingham, UK. Electronic patient records were reviewed to identify all patients presenting between November 2015 and December 2016. Data extracted included basic demographics, previous medical history, ocular diagnosis and management.
Sixty-three patients with psoriasis were identified. 37 patients (59%) were female, 26 (41%) were male with the median age at presentation being 48. 29 patients (46%) were diagnosed with ocular inflammation. Of these, 22 cases (34%) were deemed secondary to psoriasis. 28/29 (97%) received anti-inflammatory treatment, with 11/29 (38%) being followed up in clinic at a later date. 11/29 (40%) were found to have blepharitis/meibomian gland dysfunction but only 5/11 (45%) were given lid hygiene advice.Overall, 12/63 patients (19%) were receiving systemic medical therapy for their psoriasis at the time of presentation. Acute ocular inflammatory disease attributable to psoriasis was observed in 6 (50%) of these patients, with ocular surface inflammation observed in 5 patients, and anterior uveitis in 1 patient. All 6 patients received treatment for inflammatory eye disease, and 4 (66%) were reviewed in clinic at a later date.
Ocular inflammation due to psoriasis is potentially sight threatening, yet is likely to be under-recognised. Almost half of all patients in this cohort displayed evidence of ocular inflammatory disease, with over one third of all diagnoses being directly attributable to psoriasis. It is likely that this is an underestimate of the true figure, since there was insufficient information available to attribute underlying aetiology in many of the remaining cases. We advocate ocular screening at diagnosis for all patients with psoriasis, and prompt referral to hospital eye services for all patients reporting symptoms compatible with ocular inflammatory disease.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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