Autoimmune Eye Disease
Overview
The eye has a number of interesting immunological properties which alter the propensity for immune-mediated disease, including the curious feature that antigen injected into the anterior chamber induces tolerance rather than immunity. In addition, the eye has no true lymphatics, relatively poor vascularity, and, as the retina is an extension of the CNS, there is a blood-retinal barrier which limits passage of molecules in either direction. Ocular involvement is a common feature of many connective tissue and vasculitic diseases.
Uveitis
Causes
Uveitis occurs as a consequence of a wide range of systemic diseases. The site of inflammation gives some clues as to the cause.
Anterior uveitis:
seronegative arthritis (ankylosing spondylitis, Reiter’s disease, psoriatic arthropathy)
infections (herpes simplex, herpes zoster, TB)
idiopathic
vasculitis (Behçet’s syndrome).
Posterior uveitis:
vasculitis (Behçet’s syndrome, polyarteritis)
sarcoidosis
rare eye diseases (Eales’ disease, VKH, birdshot retinopathy).
Pan-uveitis:
connective tissue diseases (polychondritis, SLE)
infections (Brucella, Toxoplasma, TB, viruses)
vasculitis (Behçet’s, Wegener’s)
sympathetic ophthalmitis
sarcoidosis.
Intermediate uveitis:
Fuchs heterochromic iridocyclitis (abnormal pigmentation of the iris)
pars planitis (may be associated with MS)
juvenile rheumatoid arthritis.
Investigation (see Box 11.1)
Investigations should be aimed at the most likely causes.
Infection needs to be excluded, as the appropriate treatment for noninfectious uveitis is immunosuppression.
Box 11.1 Testing for uveitis
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