Immunological Ocular Disease

Immune-mediated disease occurs in a multitude of locations in and around the eye, including the uveal tract in uveitis, the lacrimal gland in Sjögren syndrome, and the sclera in scleritis. The eye is an immune-privileged organ. This chapter reviews several factors that contribute to the uniqueness of the immune response within the eye. Uveitis is a prototype for immune-mediated diseases that affect vision. The differential diagnosis for uveitis is broad. Clinical immunologists should be aware of the relationship between uveitis and systemic diseases, such as ankylosing spondylitis, sarcoidosis, and juvenile idiopathic arthritis. Clinical immunologists often direct systemic immunosuppression in the treatment of uveitis. Scleritis is another vision-threatening, immune-mediated disease that affects the eye; is often associated with a systemic, immune-mediated disease; and often requires systemic immunosuppression. This chapter also addresses keratitis, corneal transplantation, cancer-associated retinopathy, and age-related macular degeneration, since each of these entities is the result of an immune or inflammatory response.