What to Know About Psoriasis Around the Eyes

Psoriasis is a chronic skin disease in which cells build up quickly, resulting in patches on the skin surface that may be red or discolored, scaly, and itchy. It can be mild to severe, and is the result of immune system dysfunction.

Psoriasis most commonly affects the elbows or knees, feet or hands, nails, scalp, skin folds, or face. Any amount of skin can be affected, from small patches to large areas of skin.

When the condition affects your face, it can have a large impact on your quality of life. That’s particularly true when the sensitive skin around your eyes is involved.

Psoriasis on the face, including around the eyes, affects about half of people with psoriasis. It’s seen more often in people with long-standing or more severe psoriasis.

It’s rare for psoriasis to affect only the area around your eyes. Instead, most people with psoriasis around their eyes also have symptoms on other areas of their body.

The following symptoms may occur because of psoriasis around the eyes:

Redness or discoloration
Dry, scaly, or flaky skin
Itching and discomfort
Swollen skin
Eyelashes growing inward toward the eye (trichiasis)
Eye irritation
Vision impairment (including blurred vision due to swelling)

Psoriasis around the eyes is seen almost exclusively in plaque psoriasis, the most common form of the disease.

Aside from skin involvement around the eyes, the systemic inflammation that causes psoriasis can lead to eye health issues such as dry eye disease, blepharitis (inflammation of the eyelid), conjunctivitis (pink eye), and uveitis (inflammation of the central layer of the eye known as the uvea).

And certain treatments for psoriasis — especially topical steroids applied to the area — can increase the likelihood of vision problems, including cataracts and glaucoma.

“Sometimes in this area the patches may be less thick and less scaly, which can make the diagnosis of eyelid psoriasis harder to make,” says Faranak Kamangar, MD, a dermatologist at Palo Alto Foundation Medical Group in Palo Alto, California.

Diagnosing psoriasis in the eye area can be challenging, especially if someone doesn’t already have an established psoriasis diagnosis based on symptoms in other areas of the body.

“When we think of rashes on the eyelids, allergic contact dermatitis is more common, so it certainly could be misdiagnosed,” says Jordan Praytor, an instructor in the department of dermatology at Oregon Health & Science University in Portland.

When someone shows symptoms of what may be psoriasis around the eyes, it’s important to do a thorough skin exam of other areas of the body, says Praytor. Often, she says, doing so will reveal signs of psoriasis in more typical areas — such as around the ears, on the scalp, or within skin folds — that patients were not aware of, or did not find bothersome enough to call attention to. This “gives the provider additional clues that can help differentiate psoriasis from other diagnoses,” she says, such as eczema around the eyes.

If it’s unclear what’s causing skin symptoms around the eyes based on a physical exam, your doctor may take a small tissue sample (biopsy) for examination under a microscope.

Psoriasis around the eyes may not be treated the same as when the disease affects other areas of the body, since skin around the eyes tends to be thinner and more delicate.

“Using steroids around the eyes long-term can cause thinning of the skin, glaucoma or cataracts,” says Praytor. For this reason, she says, nonsteroid topical treatments for psoriasis are often preferred for the eye area. Topical treatments may include:

Calcipotriene
Tacrolimus
Pimecrolimus
Lower-potency corticosteroids
Zoryve
Vtama

Dr. Kamangar says that while topical steroids are a mainstay of treatment in the eye area, they need to be “limited in amount and length of application” based on your doctor’s instructions.

Systemic (non-local) treatments may be considered for psoriasis in the eye area if topical treatments are not effective, or if someone has skin symptoms on large areas of the body or psoriatic arthritis.

Systemic and other further treatments for psoriasis may include:

Oral therapies
Biologic therapies (injected)
Phototherapy (light therapy)

You may also need to take antibiotics if your eye area becomes infected, or use hydrating eye drops if you experience dry eyes.

Your doctor may recommend specific products, such as cleansers or moisturizers, to use for psoriasis in your eye area. Many products have been developed to be nonirritating and safe for people with skin conditions like psoriasis.

Recommended over-the-counter products may contain the following potentially beneficial ingredients:

Coal tar (reduces itching and skin flaking)
Hydrocortisone (reduces swelling and itching)
Oil-based moisturizing ingredients (petroleum or plant-based oils)

Unscented products may also be a good choice, since added scents can cause skin irritation.

For soreness or swelling in the eye area, applying a warm (not hot) compress can be helpful. It’s important to make sure your eye is closed when you apply it, and not to press too hard.

For itching, on the other hand, Kamangar says that applying a cold compress on the eye area can be beneficial.

Sometimes, brief exposure to direct sunlight — 5 to 10 minutes — can be beneficial for psoriasis in the eye area, says Praytor. But it’s important to avoid sun exposure most of the time, both to protect your eyes and to prevent irritation in the area because of sunburn. For this, sunscreen can be a good choice.

When it comes to oil-based moisturizers, Praytor says that calendula oil may be particularly helpful because of its soothing effects. Another option that may be effective is petroleum jelly (Vaseline).

Psoriasis can cause redness or discoloration, itching, dryness, and skin flaking around your eyes.
It may not be clear whether psoriasis or another condition, like eczema, is causing symptoms in the eye area, making it important to look for signs of psoriasis in other areas.
Nonsteroid topical treatments are often the first choice for treating psoriasis around the eyes.
Self-care measures, like using a gentle cleanser and moisturizer and applying a warm compress, can ease symptoms.

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