Diagnostic Utility of the Ocular Surface Test for Psoriasis-Associated Conjunctivitis: A Case Report

Psoriasis-associated conjunctivitis, a rare eye complication in patients with psoriasis, is not always accurately diagnosed. The symptoms may become prolonged, making treatment challenging. We report the case of a patient with psoriasis-associated conjunctivitis for whom we identified biomarkers for psoriasis in an ocular surface test. A 64-year-old female patient presented with refractory conjunctivitis that recurred despite treatment with a combination of steroids and antimicrobial eye drops and dry eye treatment. She had a long history of symptoms of psoriasis without treatment. Slit-lamp examination at the initial visit to our hospital revealed severe conjunctival hyperemia without conjunctival papillae or follicles and punctate superficial keratitis in the inferior area of the cornea. We initiated treatment with betamethasone ophthalmic solution and tacrolimus ointment for eyelid application, and her conjunctivitis improved one week following the initial visit. An ocular surface test was performed to measure the levels of cytokine and chemokine mRNA expression and profile of inflammasome-associated factors on the ocular surface. When comparing the specimens obtained at the initial visit and those taken one week later, interleukin (IL)-17A and IL-22 were expressed in the right eye, and IL-1β, prostaglandin-endoperoxide synthase 2 (PTGS2/COX-2), NOD-like receptor family CARD domain-containing protein 4 (NLRC4), Familial Mediterranean Fever (MEFV) gene, and caspase 5 (CASP5) decreased by more than six-fold. Changes in biomarkers associated with psoriasis pathology can be observed in ocular surface tests of patients with psoriasis-associated conjunctivitis.