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==Pathogenesis==
==Pathogenesis==
The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition combined with cross immunity to infectious agents, or cross immunity to self-[[antigens]] due to underlying [[autoimmune]] diseases. Up to 35% of cases of uveitis are [[idiopathic]].<ref name="pmid8619771">{{cite journal| author=Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ et al.| title=Referral patterns of uveitis in a tertiary eye care center. | journal=Arch Ophthalmol | year= 1996 | volume= 114 | issue= 5 | pages= 593-9 | pmid=8619771 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8619771  }} </ref><ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue=  | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722  }} </ref>
The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition combined with cross immunity to infectious agents, or cross immunity to self-[[antigens]] due to underlying [[autoimmune]] diseases. It is estimated that 35-50% of cases of uveitis are [[idiopathic]].<ref name="pmid8619771">{{cite journal| author=Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ et al.| title=Referral patterns of uveitis in a tertiary eye care center. | journal=Arch Ophthalmol | year= 1996 | volume= 114 | issue= 5 | pages= 593-9 | pmid=8619771 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8619771  }} </ref><ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue=  | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722  }} </ref>
Uveitis, in the setting of underlying infectious diseases, is hypothesized to be secondary to a [[T-cell]] mediated [[hypersensitivity reaction]] resulting in immunoactivating [[cytokine]] production by proliferating [[Tн17]] and [[Tн1]] cells.<ref name="pmid26438050">{{cite journal| author=Przeździecka-Dołyk J, Węgrzyn A, Turno-Kręcicka A, Misiuk-Hojło M| title=Immunopathogenic Background of Pars Planitis. | journal=Arch Immunol Ther Exp (Warsz) | year= 2016 | volume= 64 | issue= 2 | pages= 127-37 | pmid=26438050 | doi=10.1007/s00005-015-0361-y | pmc=4805694 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26438050  }} </ref><ref name="pmid25089078">{{cite journal| author=Urban B, Bakunowicz-Łazarczyk A, Michalczuk M| title=Immune recovery uveitis: pathogenesis, clinical symptoms, and treatment. | journal=Mediators Inflamm | year= 2014 | volume= 2014 | issue=  | pages= 971417 | pmid=25089078 | doi=10.1155/2014/971417 | pmc=4096001 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25089078  }} </ref> A similar mechanism is hypothesized for [[autoimmune]] etiologies of uveitis with the exception of an unknown source of the triggering [[antigen]].<ref name="pmid25742774">{{cite journal| author=Sun D, Liang D, Kaplan HJ, Shao H| title=The role of Th17-associated cytokines in the pathogenesis of experimental autoimmune uveitis (EAU). | journal=Cytokine | year= 2015 | volume= 74 | issue= 1 | pages= 76-80 | pmid=25742774 | doi=10.1016/j.cyto.2014.12.017 | pmc=4457592 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25742774  }} </ref><ref name="pmid25769932">{{cite journal| author=Bi HS, Liu ZF, Cui Y| title=Pathogenesis of innate immunity and adaptive immunity in the mouse model of experimental autoimmune uveitis. | journal=J Chin Med Assoc | year= 2015 | volume= 78 | issue= 5 | pages= 276-82 | pmid=25769932 | doi=10.1016/j.jcma.2015.01.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25769932  }} </ref><ref name="pmid21787221">{{cite journal| author=Horai R, Caspi RR| title=Cytokines in autoimmune uveitis. | journal=J Interferon Cytokine Res | year= 2011 | volume= 31 | issue= 10 | pages= 733-44 | pmid=21787221 | doi=10.1089/jir.2011.0042 | pmc=3189550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21787221  }} </ref><ref name="pmid19234216">{{cite journal| author=Ke Y, Liu K, Huang GQ, Cui Y, Kaplan HJ, Shao H et al.| title=Anti-inflammatory role of IL-17 in experimental autoimmune uveitis. | journal=J Immunol | year= 2009 | volume= 182 | issue= 5 | pages= 3183-90 | pmid=19234216 | doi=10.4049/jimmunol.0802487 | pmc=3275433 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19234216  }} </ref>
Uveitis, in the setting of underlying infectious diseases, is hypothesized to be secondary to a [[T-cell]] mediated [[hypersensitivity reaction]] resulting in immunoactivating [[cytokine]] production by proliferating [[Tн17]] and [[Tн1]] cells.<ref name="pmid26438050">{{cite journal| author=Przeździecka-Dołyk J, Węgrzyn A, Turno-Kręcicka A, Misiuk-Hojło M| title=Immunopathogenic Background of Pars Planitis. | journal=Arch Immunol Ther Exp (Warsz) | year= 2016 | volume= 64 | issue= 2 | pages= 127-37 | pmid=26438050 | doi=10.1007/s00005-015-0361-y | pmc=4805694 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26438050  }} </ref><ref name="pmid25089078">{{cite journal| author=Urban B, Bakunowicz-Łazarczyk A, Michalczuk M| title=Immune recovery uveitis: pathogenesis, clinical symptoms, and treatment. | journal=Mediators Inflamm | year= 2014 | volume= 2014 | issue=  | pages= 971417 | pmid=25089078 | doi=10.1155/2014/971417 | pmc=4096001 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25089078  }} </ref> A similar mechanism is hypothesized for [[autoimmune]] etiologies of uveitis with the exception of an unknown source of the triggering [[antigen]].<ref name="pmid25742774">{{cite journal| author=Sun D, Liang D, Kaplan HJ, Shao H| title=The role of Th17-associated cytokines in the pathogenesis of experimental autoimmune uveitis (EAU). | journal=Cytokine | year= 2015 | volume= 74 | issue= 1 | pages= 76-80 | pmid=25742774 | doi=10.1016/j.cyto.2014.12.017 | pmc=4457592 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25742774  }} </ref><ref name="pmid25769932">{{cite journal| author=Bi HS, Liu ZF, Cui Y| title=Pathogenesis of innate immunity and adaptive immunity in the mouse model of experimental autoimmune uveitis. | journal=J Chin Med Assoc | year= 2015 | volume= 78 | issue= 5 | pages= 276-82 | pmid=25769932 | doi=10.1016/j.jcma.2015.01.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25769932  }} </ref><ref name="pmid21787221">{{cite journal| author=Horai R, Caspi RR| title=Cytokines in autoimmune uveitis. | journal=J Interferon Cytokine Res | year= 2011 | volume= 31 | issue= 10 | pages= 733-44 | pmid=21787221 | doi=10.1089/jir.2011.0042 | pmc=3189550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21787221  }} </ref><ref name="pmid19234216">{{cite journal| author=Ke Y, Liu K, Huang GQ, Cui Y, Kaplan HJ, Shao H et al.| title=Anti-inflammatory role of IL-17 in experimental autoimmune uveitis. | journal=J Immunol | year= 2009 | volume= 182 | issue= 5 | pages= 3183-90 | pmid=19234216 | doi=10.4049/jimmunol.0802487 | pmc=3275433 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19234216  }} </ref>


Revision as of 18:11, 27 July 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

Overview

The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition and an acquired cross immunity to infectious agents, or cross immunity to self-antigens due to underlying autoimmune diseases. From 35% up to 50% of cases of uveitis are idiopathic.[1][2]Development of uveitis is hypothesized to be the result of a genetic predisposition for acquiring the disease. Contributions of several Human Leukocyte Antigen (HLA) alleles are most commonly implicated.[2][3]

Pathogenesis

The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition combined with cross immunity to infectious agents, or cross immunity to self-antigens due to underlying autoimmune diseases. It is estimated that 35-50% of cases of uveitis are idiopathic.[1][2] Uveitis, in the setting of underlying infectious diseases, is hypothesized to be secondary to a T-cell mediated hypersensitivity reaction resulting in immunoactivating cytokine production by proliferating Tн17 and Tн1 cells.[3][4] A similar mechanism is hypothesized for autoimmune etiologies of uveitis with the exception of an unknown source of the triggering antigen.[5][6][7][8]

Genetics

Development of uveitis is hypothesized to be the result of a genetic predisposition for acquiring the disease. Contributions of several Human Leukocyte Antigen (HLA) alleles are most commonly implicated. This includes, HLA-B27 in seronegative spondyloarthropathies, HLA-A29 in birdshot chorioretinopathy, HLA-B51 in Behcet syndrome and multiple sclerosis, HLA-B8, HLA-DR15, and HLA-DR2.[2][3]

Associated Conditions

The following conditions are associated with uveitis:[1][2][9]

Gross Pathology

The following are images of the gross pathology of uveitis:[10][11]

  • Uveitis with pus in the anterior chamber
    Uveitis with pus in the anterior chamber
  • Anterior Uveitis
    Anterior Uveitis

Microscopic Pathology

The following are images of the microscopic pathology of uveitis:[12]

  • Uveitis with infiltration of lymphocytes
    Uveitis with infiltration of lymphocytes
  • Uveitis with granulomatous inflammation and infiltration of the choroid by lymphocytes and macrophages.
    Uveitis with granulomatous inflammation and infiltration of the choroid by lymphocytes and macrophages.

References

  1. ↑ 1.0 1.1 1.2 Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ; et al. (1996). "Referral patterns of uveitis in a tertiary eye care center". Arch Ophthalmol. 114 (5): 593–9. PMID 8619771.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Guly CM, Forrester JV (2010). "Investigation and management of uveitis". BMJ. 341: c4976. doi:10.1136/bmj.c4976. PMID 20943722.
  3. ↑ 3.0 3.1 3.2 Przeździecka-Dołyk J, Węgrzyn A, Turno-Kręcicka A, Misiuk-Hojło M (2016). "Immunopathogenic Background of Pars Planitis". Arch Immunol Ther Exp (Warsz). 64 (2): 127–37. doi:10.1007/s00005-015-0361-y. PMC 4805694. PMID 26438050.
  4. ↑ Urban B, Bakunowicz-Łazarczyk A, Michalczuk M (2014). "Immune recovery uveitis: pathogenesis, clinical symptoms, and treatment". Mediators Inflamm. 2014: 971417. doi:10.1155/2014/971417. PMC 4096001. PMID 25089078.
  5. ↑ Sun D, Liang D, Kaplan HJ, Shao H (2015). "The role of Th17-associated cytokines in the pathogenesis of experimental autoimmune uveitis (EAU)". Cytokine. 74 (1): 76–80. doi:10.1016/j.cyto.2014.12.017. PMC 4457592. PMID 25742774.
  6. ↑ Bi HS, Liu ZF, Cui Y (2015). "Pathogenesis of innate immunity and adaptive immunity in the mouse model of experimental autoimmune uveitis". J Chin Med Assoc. 78 (5): 276–82. doi:10.1016/j.jcma.2015.01.002. PMID 25769932.
  7. ↑ Horai R, Caspi RR (2011). "Cytokines in autoimmune uveitis". J Interferon Cytokine Res. 31 (10): 733–44. doi:10.1089/jir.2011.0042. PMC 3189550. PMID 21787221.
  8. ↑ Ke Y, Liu K, Huang GQ, Cui Y, Kaplan HJ, Shao H; et al. (2009). "Anti-inflammatory role of IL-17 in experimental autoimmune uveitis". J Immunol. 182 (5): 3183–90. doi:10.4049/jimmunol.0802487. PMC 3275433. PMID 19234216.
  9. ↑ American Academy of Ophthalmology EyeWiki(2015)http://eyewiki.aao.org/Category:Uveitis
  10. ↑ Wikipedia Uveitis(2006)https://en.wikipedia.org/wiki/Uveitis#/media/File:Hypopyon.jpg
  11. ↑ University of Michigan Eyes Have It(2009)http://kellogg.umich.edu/theeyeshaveit/red-eye/anterior-uveitis.html
  12. ↑ Arevalo JF, Garcia RA, Al-Dhibi HA, Sanchez JG, Suarez-Tata L (2012). "Update on sympathetic ophthalmia". Middle East Afr J Ophthalmol. 19 (1): 13–21. doi:10.4103/0974-9233.92111. PMC 3277011. PMID 22346110.

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