Psoriasis and intraocular inflammation

Presented in this series were seven men and three women. Ages when seen, ranged from 32 to 68 years (average 54). Psoriasis had begun in childhood in the women and in the late 20's and 30's in the men. arthritis (ankylosing spondylitis) was present in only one. Their ocular inflammations began from ages 26 to 62 (average 41). The onset of the inflammtion was acute iritis in four and an indolent iridocylitis in six. All but one were bilateral and chronic. Systemic corticosteroid therapy has been used in eight of the ten patients described in this report. Doses no higher than 30 mg of prednisone per day were used to initiate reversal of the inflammatory response. These patients are older, have an indolent onset bilateral uveitis with dense vitreous debris, retinal abnormalities, and are extremely sensitive to systemic corticosteroids. Many of these patients had undergone the series of clinical evaluations known as a 'uveitis survey.' Many different systemic abnormalities were found and merited treatment which rarely made a difference in their ocular disease, though two improved after infected teeth were treated. Assuming that these ocular diseases were related to psoriasis, one can then challenge the value of anything found by a 'uveitis survey.' The rarity of this combination of ocular inflammations in patients with psoriasis makes it risky to propose that this is a significant association. Arguments that this is a disease entity began with the clinical similarities: older age, indolent onset, vitreous and retinal involvement, and the extreme sensitivity to systemic corticosteroids. None of these patients had psoriatic arthritis and only one had ankylosing spondylitis. The best explanation for the fact that this disorder has not been emphasized in the past would be an attitude of ophthalmologists and physicians that the eye and skin disease were coincident.