Allergic uveitis: causes, symptoms, diagnosis, treatment

In the immunopathology of the organ of vision, the vascular tract is given the leading importance, as evidenced by the large number of published works. Particularly intensive research is conducted in recent years. The increased interest in this department of the eyeball is explained by the fact that the allergy in its pathology is represented very widely, the diseases are common, they often differ in severe course and bad outcome, their diagnosis is difficult, and the treatment does not always satisfy patients.

The tissues of the uveal tract are highly sensitive to the most diverse allergens, among which the endogenous stimuli that are brought by blood prevail. Apparently, a massive supply of allergens in the uveal tract causes an immediate reaction with predominance of the exudative component, and in less intensive, but longer-lasting effects, the vascular membrane responds predominantly to proliferation.

According to the well-known classification of Woods (1956), all inflammatory diseases of the vascular tract are divided into granulomatous and non-granulomatous. There is a growing assertion that the cause of granulomatous lesions is the hematogenous invasion of the infectious origin from some foci in the body. Infectious agents enter the eye and cause formation in the vascular tract of their specific granulomas. Depending on the type of infection, the clinic of these diseases has its differences, facilitating the etiologic diagnosis, but they are rarely observed.

Non-granulomatous uveitis, reflecting the reactions of sensitized uveal tissue to endogenous, less often exogenous allergens, unfolds primarily as allergic processes. Manifesting plastic, serous-plastic and serous anterior uveitis, panoveitis and diffuse posterior uveitis, these often very serious diseases almost have signs that would convincingly attest to a particular etiology. The finding of this, as a rule, requires a special allergic examination of the patient.

Most often, non-granulomatous uveal processes cause common chronic infections. Along with tuberculosis, toxoplasmosis, viral and other infections, streptococci of latent focal foci of infection occupy a large place in the development of infectious-allergic uveitis. With the help of appropriate allergens, this infection is detected in 2-20% of patients with uveitis of unclear etiology and can overlap for tuberculosis and other eye diseases.

The vascular tract is highly susceptible to autoimmune reactions, often manifested by severe uveitis. Antigens that arise as a result of metabolic disorders in patients with diabetes mellitus, gout, diathesis, liver disease, blood, etc., serve as irritants. An allergic component in the pathogenesis of uveal lesions on the basis of such suffering always occurs, worsens the course of the disease and makes it difficult to treat, since the most active immunosuppressive agents of such patients are often contraindicated.

The vascular membrane is very sensitive to allergens arising from the eye's own tissues during their mechanical, chemical, physical and other injuries. The high allergenicity of the endothelium of the cornea was noted above, but it is no less high in the tissue of the vascular (its pigment melanin - tuptena) and the reticular membrane. Sensitization of the eye (and body) by its own allergens with burns, penetrating wounds, contusions, radiation, cold and other influences leads to the formation of appropriate autoantibodies, and the further receipt of the same antigens from pathological eye foci or nonspecific effects cause the development of immediate allergic reactions damage area limits. This, in particular, is the mechanism presented here in a very simplistic way, one of the most important features of the pathogenesis of eye burns and aseptic traumatic iridocyclitis. Recognition of allergic factors leading in this pathology allows us to substantiate its corticosteroid and other antiallergic therapy, which, as is well known, gives a pronounced effect in many patients.

To the autoimmune diseases S.Yu. Stukalov (1975) and many other researchers refer sympathetic ophthalmia, thus confirming the validity of the "antigenic anaphylactic theory of sympathetic inflammation" A. Elshnig put forward at the beginning of this century.

Autoimmune essentially are oculogenic allergic uveitis in patients with old untreated retinal detachments or with decaying intraocular tumors.

A special place in ophthalmoallergology is the lens. Even its unchanged substance, appearing for some reason outside the capsule, is not transferred by the eye: there is no immunological tolerance of the organism to the lens tissue. Such tissues are called primary or natural allergens. Each ophthalmologist had to observe how violently, up to the endophthalmitis, the eye reacts to the lens masses falling into the anterior chamber with perforating wounds, what severe inflammations are complicated by overripe and overripe cataracts. Some authors consider such processes as phacotoxic, others cautiously talk about "phacogenous" inflammations, while others are confidently called their phakoanaphylactic iridocyclitis and endophthalmitis.

The discrepancy of opinions indicates that the pathogenesis of eye reactions on the lens tissue is far from being revealed, much does not fit into the framework of conventional concepts. Unconvincing, for example, skin tests with a lens antigen, it is useless for any therapeutic treatment. The eye saves only an emergency release from the lens and its masses.

[1], [2], [3], [4], [5]