Radha Annamalai

Abstract

Purpose: To analyse various ocular abnormalities and visual morbidity in patients with psoriasis and to detect ocular complications following psoriasis treatment. Materials and Methods: A prospective observational study was conducted among 120 psoriasis patients. All patients underwent slit lamp examination, indirect ophthalmoscopy, Schirmer’s test, Tear breakup time and Rose Bengal staining and ancillary investigations when required. Results: Among 120 patients, the prevalence of ocular manifestation was 57%, of whom 22% were symptomatic. Ocular features were most common in scalp psoriasis and pustular psoriasis. Disease duration was not found to have any impact on the severity of ocular manifestation. The most common ophthalmic feature was ocular surface disorder (46%), followed by cataract (30%), meibomitis (17%) and blepharitis in 16%. Correlation between tests was calculated using kappa coefficient and statistical significance was found in the pattern of conjunctival staining with a p value of 0.02. Out of 9 patients with psoriatic arthritis, 3% showed signs of chronic uveitis. Steroid induced glaucoma was seen in 27% and ocular hypertension in 21%. Corticosteroid used in systemic management frequently caused visual morbidity. Conclusion: Ocular signs and symptoms in psoriasis may be subtle and overlooked, hence complete ophthalmic examination is recommended for early detection of ocular abnormalities. Early treatment for dry eye is important to prevent irreversible ocular surface changes. Regular monitoring prevents steroid induced cataract and steroid induced glaucoma. As multisystem involvement is seen in psoriasis, a multidisciplinary approach reduces ocular morbidity. Keywords: Cataract, Corticosteroids, Dry eye, Psoriasis, Glaucoma.

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Abstract

Background: Glaucoma and hypertension share a common pathophysiology of altered sodium transport in the renal and ciliary epithelium and can co exist. High blood pressure is a significant risk factor for glaucoma progression due to intraocular pressure spikes. Aims: This study was performed to evaluate the association of hypertension with glaucoma and to assess the extent of optic disc damage, the role of anti hypertensive medications and visual morbidity. Materials and Methods: This is a prospective, multidisciplinary study performed on a cohort of 118 hypertensive patients over 1 year. Ophthalmic examination, ancillary ocular investigations, systemic tests and multi speciality referrals were obtained for all patients. Results: Among 118 hypertensive patients, 64 (54.8%) had glaucoma. 65 patients (55.1%) were female and 53 patients (44.1%) male. Age group most frequently affected was between 60 and 70 years. There was increased incidence of ocular hypertension which was statistically significant (p value of 0.02). The range of IOP in those on anti hypertensive medications was 10-16 mmHg which was statistically significant (p value = 0. 03). Discussion: Risk of glaucoma in hypertension was higher in women. An elevation of diastolic blood pressure is more significant than systolic BP in raising IOP. Decreased IOP was highest among patients taking calcium channel blockers. Conclusion: Hypertension can cause both reduction and elevation in IOP. Treatment of hypertension does lower the IOP and prevent further progression of glaucoma and prevent any visual loss. Keywords: Blood pressure, Glaucoma, Hypertension, Intraocular pressure, Ocular hypertension.

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