Intraocular inflammation in autoimmune diseases.
BACKGROUND
The uveal tract represents the vascular organ of the eye. In addition to providing most of the blood supply to the intraocular structures, it acts as a conduit for immune cells, particularly lymphocytes, to enter the eye. Consequently, the uveal tract is represented in many intraocular inflammatory processes. Uveitis is probably a misnomer unless antigens within the uvea are the direct targets of the inflammatory process. A better term of the condition is "intraocular inflammation" (IOI).


OBJECTIVE
To review the presence of IOI in autoimmune diseases, the immunopathogenic mechanisms leading to disease, and treatment.


METHODS
We reviewed the English medical literature by using MEDLINE (1984-2003) employing the terms "uveitis," "intraocular inflammation," and "autoimmune diseases."


RESULTS
An underlying autoimmune disease was identified in up to 40% of patients with IOI, and included spondyloarthropathies, Behcets disease, sarcoidosis, juvenile chronic arthritis, Vogt-Koyanagi-Harada syndrome (an inflammatory syndrome including uveitis with dermatologic and neurologic manifestations), immune recovery syndrome, and uveitis with tubulointerstitial disease. The immunopathogenesis of IOI involves enhanced T-cell response. Recently, guidelines for the use of immunosuppressive drugs for inflammatory eye disease were established and include: corticosteroids, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, cyclophosphamide, and chlorambucil. New therapies with limited experience include the tumor necrosis factor alpha inhibitors, interferon alfa, monoclonal antibodies against lymphocyte surface antigens, intravenous immunoglobulin (IVIG), and the intraocular delivery of immunosuppressive agents.


CONCLUSIONS
An underlying autoimmune disease was identified in up to 40% of patients with IOI. Immunosuppressive drugs, biologic agents, and IVIG are employed for the treatment of IOI in autoimmune diseases.
Pras
Eran
E
Department of Ophthalmology, Sapir Medical Center, Israel.
Neumann
Ron
R
Zandman-Goddard
Gisele
G
Levy
Yair
Y
Assia
Ehud I
EI
Shoenfeld
Yehuda
Y
Langevitz
Pnina
P
D001327:Autoimmune Diseases / Q000150:complications / Q000276:immunology* / Q000473:pathology*; D005128:Eye Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000188:drug therapy; D016239:MEDLINE; D014605:Uveitis / Q000150:complications / Q000276:immunology* / Q000473:pathology*
D007166:Immunosuppressive Agents