nach oben

Current Allergy and Asthma Reports

Erschienen in:

12.07.2023

Autoimmune Inflammatory Eye Disease: Demystifying Clinical Presentations for the Internist

verfasst von: Richmond Woodward, Sri Meghana Konda, Dilraj S. Grewal

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 8/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Provide a framework for recognizing key symptoms and clinical findings in patients with autoimmune inflammatory eye disease.

Recent Findings

The most common manifestations of autoimmune inflammatory eye disease are episcleritis, scleritis, uveitis (anterior, intermediate, posterior, and panuveitis), and keratoconjunctivitis sicca. Etiologies can be idiopathic or in association with a systemic autoimmune condition. Referral of patients who may have scleritis is critical for patients presenting with red eyes. Referral of patients who may have uveitis is critical for patients presenting often with floaters and vision complaints. Attention should also be directed to aspects of the history that might suggest a diagnosis of a systemic autoimmune condition, immunosuppression, drug-induced uveitis, or the possibility of a masquerade condition. Infectious etiologies should be ruled out in all cases.

Summary

Patients with autoimmune inflammatory eye disease may present with ocular or systemic symptoms alone, or in combination. Collaboration with ophthalmologists and other relevant specialists is vital to optimal long-term medical care.

Nussenblatt RB, Whitcup SM. Uveitis: fundamentals and clinical practice. 4th ed. Mosby: Elsevier; 2010.

Ness T, Boehringer D, Heinzelmann S. Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center. Orphanet J Rare Dis. 2017;12(1):81. https://doi.org/10.1186/s13023-017-0638-9.CrossRefPubMedPubMedCentral

Zlatanovic G, Veselinovic D, Cekic S, et al. Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci. 2010;10(4):323–7. https://doi.org/10.17305/bjbms.2010.2680.CrossRefPubMedPubMedCentral

Amador-Patarroyo MJ, Cristina Peñaranda A, Teresa Bernal M. Autoimmune uveitis. In: Anaya JM, Shoenfeld Y, Rojas-Villarraga A, et al., editors. Autoimmunity: from bench to bedside [Internet]. Bogota (Colombia): El Rosario University Press 2013: Chapter 37. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459445/.

Makunyane P, Mathebula S. Ocular manifestations of HIV and AIDS patients on antiretroviral therapy in a tertiary hospital in South Africa. African Vis Eye Health. 2021;80(1)6. https://doi.org/10.4102/aveh.v80i1.610.

Xu H, Rao NA. Grand challenges in ocular inflammatory diseases. Front Ophthalmol. 2022;2:756689. https://doi.org/10.3389/fopht.2022.756689.

Molzer C, Heissigerova J, Wilson HM, et al. Immune privilege: the microbiome and uveitis. Front Immunol. 2020;11:608377. https://doi.org/10.3389/fimmu.2020.608377.

Zamani G, Hajipour A, Ganjeifar B, et al. Intraocular lymphoma masquerading as unilateral hypopyon anterior uveitis: a case report. J Ophthalmic Inflamm Infect. 2022;12(1):25. https://doi.org/10.1186/s12348-022-00302-5.CrossRefPubMedPubMedCentral

Monsalvo S, Serrano C, Prieto E, et al. Unilateral uveitis masquerade syndrome caused by diffuse large B-cell lymphoma diagnosed using multiparametric flow cytometry of the aqueous humor. Cytometry B Clin Cytom. 2017;92(4):286–90. https://doi.org/10.1002/cyto.b.21361.CrossRefPubMed

10.

Chang CJ, Chen SJ, Hwang DK, Liu CJ. Bilateral anterior uveitis after immunotherapy for malignant melanoma. Taiwan J Ophthalmol. 2018;8(3):173–5. https://doi.org/10.4103/tjo.tjo_88_17.CrossRefPubMedPubMedCentral

11.

Lerner A. 11th Annual Congress on Immunology: the world incidence and prevalence of autoimmune diseases is increasing. J Timely Top Clin Immunol. 2018;2:42. https://doi.org/10.1038/1931030a0.

12.

Schonberg S, Stokkermans TJ. Episcleritis. [Updated 2022 Sep 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023; Available from: https://www.ncbi.nlm.nih.gov/books/NBK534796/.

13.

Duplechain A, Conrady CD, Patel BC, et al. Uveitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023; Available from: https://www.ncbi.nlm.nih.gov/books/NBK540993/.

14.

Yuan F, Zhang Y, Yan X. Bilateral acute angle closure glaucoma as an initial presentation of Vogt-Koyanagi-Harada syndrome: a clinical case report. Eur J Ophthalmol. 2022;32(1):NP230-NP234. https://doi.org/10.1177/1120672120951442.

15.

Stern ME, Gao J, Siemasko KF, et al. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res. 2004;78(3):409–16. https://doi.org/10.1016/j.exer.2003.09.003.CrossRefPubMed

16.

Stern ME, Schaumburg CS, Pflugfelder SC. Dry eye as a mucosal autoimmune disease. Int Rev Immunol. 2013;32(1):19–41. https://doi.org/10.3109/08830185.2012.748052.CrossRefPubMedPubMedCentral

17.

Rojas-Carabali W, Mejia-Salgado G, Cifuentes-Gonzalez C, et al. Clinical relationship between dry eye disease and uveitis: a scoping review. J Ophthalmic Inflamm Infect. 2023;13(1):2. https://doi.org/10.1186/s12348-022-00323-0.CrossRefPubMedPubMedCentral

18.

Stern ME, Pflugfelder SC. What we have learned from animal models of dry eye. Int Ophthalmol Clin. 2017;57(2):109–18. https://doi.org/10.1097/IIO.0000000000000169.CrossRefPubMedPubMedCentral

19.

Pflugfelder SC, Stern ME. The cornea in keratoconjunctivitis sicca. Exp Eye Res. 2020:201:108295. https://doi.org/10.1016/j.exer.2020.108295.

20.

Craig J, Downie L. Tears and contact lenses in contact lenses (Sixth Edition), 2019 Editor(s): Anthony J. Phillips, Lynne Speedwell, Elsevier, 2019.

21.

Gottsch JD. Autoimmune keratitis. In: Pleyer U, Foster CS (eds). Uveitis and immunological disorders. Essentials in ophthalmology. Springer, Berlin, Heidelberg; 2017. https://doi.org/10.1007/978-3-540-30798-3_5.

22.

Cao Y, Zhang W, Wu J, et al. Peripheral ulcerative keratitis associated with autoimmune disease: pathogenesis and treatment. J Ophthalmol. 2017;2017:7298026. https://doi.org/10.1155/2017/7298026.CrossRefPubMedPubMedCentral

23.

Markovitz E, Perry ZH, Tsumi E, Abu-Shakra M. Ocular involvement and its’ manifestations in rheumatoid arthritis patients. Harefuah. 2011;150(9):713–8, 751.

24.

• Glover K, Mishra D, Singh TRR. Epidemiology of ocular manifestations in autoimmune disease. Front Immunol. 2021:12:744396. https://doi.org/10.3389/fimmu.2021.744396. Comprehensive review of ocular complications of systemic autoimmune diseases including the impact of gender, hormonal effects, and geographic and ethnic differences on the prevalence of these ocular complications.

25.

Troncoso LL, Biancardi AL, de Moraes HV Jr, Zaltman C. Ophthalmic manifestations in patients with inflammatory bowel disease: a review World J Gastroenterol. 2017;23(32):5836–5848 https://doi.org/10.3748/wjg.v23.i32.5836

26.

Taylor AW. Ocular immune privilege and transplantation. Front Immunol. 2016;7:37. https://doi.org/10.3389/fimmu.2016.00037.CrossRefPubMedPubMedCentral

27.

Shah J, Shah A, Hassman L, Gutierrez A. Ocular manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2021;27(11):1832–8. https://doi.org/10.1093/ibd/izaa359.CrossRefPubMed

28.

Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal manifestations of inflammatory bowel disease: current concepts, treatment, and implications for disease management. Gastroenterology. 2021;161(4):1118–32. https://doi.org/10.1053/j.gastro.2021.07.042.CrossRefPubMed

29.

Orchard TR, Chua CN, Ahmad T, Cheng H, Welsh KI, Jewell DP. Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes. Gastroenterology. 2002;123(3):714–8. https://doi.org/10.1053/gast.2002.35396.CrossRefPubMed

30.

Barberio J, Kim SC, Roh M, et al. Risk of uveitis in patients with inflammatory bowel disease on immunosuppressive drug therapy. Crohns Colitis 360. 2020;2(3):otaa041. https://doi.org/10.1093/crocol/otaa041.

31.

Zajac H, Turno-Krecicka A. Ocular manifestations of Behcet’s disease: an update on diagnostic challenges and disease management. J Clin Med. 2021;10(21). https://doi.org/10.3390/jcm10215174.

32.

Uddin Z, Khan A, Haroon M, et al. Spectrum of ocular manifestations of rheumatic autoimmune diseases: a tertiary care experience in Pakistan. J Ayub Med Coll Abbottabad. 2021;33(4):612–6.PubMed

33.

Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Ophthalmol. 2005;50(4):364–88. https://doi.org/10.1016/j.survophthal.2005.04.003.CrossRefPubMed

34.

Monnet D, Breban M, Hudry C, et al. Ophthalmic findings and frequency of extraocular manifestations in patients with HLA-B27 uveitis: a study of 175 cases. Ophthalmology. 2004;111(4):802–9. https://doi.org/10.1016/j.ophtha.2003.07.011.CrossRefPubMed

35.

Linssen A, Meenken C. Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis. Am J Ophthalmol. 1995;120(3):351–61. https://doi.org/10.1016/s0002-9394(14)72165-8.CrossRefPubMed

36.

Rothova A, van Veenedaal WG, Linssen A, et al. Clinical features of acute anterior uveitis. Am J Ophthalmol. 1987;103(2):137–45. https://doi.org/10.1016/s0002-9394(14)74218-7.CrossRefPubMed

37.

Jhaj G, Kopplin LJ. Ocular features of the HLA-B27-positive seronegative spondyloarthropathies. Curr Opin Ophthalmol. 2018;29(6):552–7. https://doi.org/10.1097/ICU.0000000000000525.CrossRefPubMed

38.

Baldini C, Talarico R, Tzioufas AG, Bombardieri S. Classification criteria for Sjogren’s syndrome: a critical review. J Autoimmun. 2012;39(1–2):9–14. https://doi.org/10.1016/j.jaut.2011.12.006.CrossRefPubMed

39.

Tzioufas AG, Kapsogeorgou EK, Moutsopoulos HM. Pathogenesis of Sjogren’s syndrome: what we know and what we should learn. J Autoimmun. 2012;39(1–2):4–8. https://doi.org/10.1016/j.jaut.2012.01.002.CrossRefPubMed

40.

Shiboski SC, Shiboski CH, Criswell L, et al. American College of Rheumatology classification criteria for Sjogren’s syndrome: a data-driven, expert consensus approach in the Sjogren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken). 2012;64(4):475–87. https://doi.org/10.1002/acr.21591.CrossRefPubMed

41.

Methodologies to diagnose and monitor dry eye disease. report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5(2):108–52. https://doi.org/10.1016/s1542-0124(12)70083-6.CrossRef

42.

Foulks GN, Forstot SL, Donshik PC, et al. Clinical guidelines for management of dry eye associated with Sjogren disease. Ocul Surf. 2015;13(2):118–32. https://doi.org/10.1016/j.jtos.2014.12.001.CrossRefPubMed

43.

Valenzuela J, Echegaray JJ, Dodds E, et al. Ophthalmic manifestations of hodgkin lymphoma: a review. Ocul Oncol Pathol. 2021;7(6):381–9. https://doi.org/10.1159/000519032.CrossRefPubMedPubMedCentral

44.

Hajj-Ali RA, Lowder C, Mandell BF. Uveitis in the internist’s office: are a patient’s eye symptoms serious? Cleve Clin J Med. 2005;72(4):329–39. https://doi.org/10.3949/ccjm.72.4.329.CrossRefPubMed

45.

Cheng CY, Chen PY, Lin CJ. Intraocular xanthomatous tumor presenting as fulminant uveitis. Eye (Lond). 2015;29(2):296–8. https://doi.org/10.1038/eye.2014.287.CrossRefPubMed

46.

Chan CC, Gonzales J, Hidayat A. Albert & Jakobiec’s principles & practice of ophthalmology: 4-volume set. Albert D, Miller J, Azar D, editors. Expert Consult. 2008.

47.

Rothova A, Hajjaj A, de Hoog J, et al. Uveitis causes according to immune status of patients. Acta Ophthalmol. 2019;97(1):53–9. https://doi.org/10.1111/aos.13877.CrossRefPubMed

48.

Sudharshan S, Nair N, Curi A, et al. Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - an update. Indian J Ophthalmol. 2020;68(9):1787–98. https://doi.org/10.4103/ijo.IJO_1248_20.CrossRefPubMedPubMedCentral

49.

Agarwal M, Dutta Majumder P, Babu K, et al. Drug-induced uveitis: a review. Indian J Ophthalmol. 2020;68(9):1799–807. https://doi.org/10.4103/ijo.IJO_816_20.CrossRefPubMedPubMedCentral

50.

Iqbal KM, Hay MW, Emami-Naeini P. Medication-induced uveitis: an update. J Ophthalmic Vis Res. 2021;16(1):84–92. https://doi.org/10.18502/jovr.v16i1.8254.CrossRefPubMedPubMedCentral

51.

Hargadon KM, Johnson CE, Williams CJ. Immune checkpoint blockade therapy for cancer: an overview of FDA-approved immune checkpoint inhibitors. Int Immunopharmacol. 2018;62:29–39. https://doi.org/10.1016/j.intimp.2018.06.001.CrossRefPubMed

52.

Medawar PB. Immunity to homologous grafted skin; the fate of skin homografts transplanted to the brain, to subcutaneous tissue, and to the anterior chamber of the eye. Br J Exp Pathol. 1948;29(1):58–69.PubMedPubMedCentral

53.

Forrester JV, Kuffova L, Dick AD. Autoimmunity, autoinflammation, and infection in uveitis. Am J Ophthalmol. 2018;189:77–85. https://doi.org/10.1016/j.ajo.2018.02.019.CrossRefPubMed

54.

Niederkorn JY. The eye sees eye to eye with the immune system: the 2019 Proctor Lecture. Invest Ophthalmol Vis Sci. 2019;60(13):4489–95. https://doi.org/10.1167/iovs.19-28632.CrossRefPubMedPubMedCentral

55.

Whitcup SM. The double-edged ocular immune response: the Cogan lecture. Invest Ophthalmol Vis Sci. 2000;41(11):3243–8.PubMed

56.

• Nieto-Aristizabal I, Mera JJ, Giraldo JD, et al. From ocular immune privilege to primary autoimmune diseases of the eye. Autoimmun Rev. 2022;21(8):103122. https://doi.org/10.1016/j.autrev.2022.103122. Highlights possible mechanisms of primary autoimmune diseases of the eye. Uniquely describes and compares individual ocular diseases with their possible primary autoimmune pathogenesis.

57.

• Zysset-Burri DC, Morandi S, Herzog EL, et al. The role of the gut microbiome in eye diseases. Prog Retin Eye Res. 2023;92:101117. https://doi.org/10.1016/j.preteyeres.2022.101117. Relevant synthesis of research on interactions between the gut and eye on a molecular level that may contribute to ocular inflammation.

58.

Ye Z, Zhang N, Wu C, et al. A metagenomic study of the gut microbiome in Behcet’s disease. Microbiome. 2018;6(1):135. https://doi.org/10.1186/s40168-018-0520-6.CrossRefPubMedPubMedCentral

59.

Huang X, Ye Z, Cao Q, et al. Gut microbiota composition and fecal metabolic phenotype in patients with acute anterior uveitis. Invest Ophthalmol Vis Sci. 2018;59(3):1523–31. https://doi.org/10.1167/iovs.17-22677.CrossRefPubMed

60.

Horai R, Caspi RR. Microbiome and autoimmune uveitis Front Immunol. 2019;10:232. https://doi.org/10.3389/fimmu.2019.00232.CrossRefPubMed

61.

Lin P. The role of the intestinal microbiome in ocular inflammatory disease. Curr Opin Ophthalmol. 2018;29(3):261–6. https://doi.org/10.1097/ICU.0000000000000465.CrossRefPubMed

62.

Al-Najar M, Altah M, Aljakhim D. An overview of ocular microbiology: ocular microbiota, the effect of contact lenses and ocular disease. Arch Phar & Pharmacol Res. 1(5):2019. https://doi.org/10.33552/APPR.2019.01.000522.

63.

Locatelli A. Shirine Mohamed, Karine Angioi; Epidemiology and etiology on uveitis in a department of internal medicine: a retrospective study on 441 patients. Invest Ophthalmol Vis Sci. 2014;55(13):5324.

64.

•• Van Bentum RE, Van den Berg JM, Wolf SE, et al. Multidisciplinary management of auto-immune ocular diseases in adult patients by ophthalmologists and rheumatologists. Acta Ophthalmol. 2021:99(2):e164–e170. https://doi.org/10.1111/aos.14548. Retrospective chart review demonstrating clinical benefits, including significant corticosteroid tapering, resulting from shared management of adults with autoimmune eye disease.

Titel: Autoimmune Inflammatory Eye Disease: Demystifying Clinical Presentations for the Internist
verfasst von: Richmond Woodward
Sri Meghana Konda
Dilraj S. Grewal
Publikationsdatum: 12.07.2023
Verlag: Springer US
Erschienen in: Current Allergy and Asthma Reports / Ausgabe 8/2023
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI: https://doi.org/10.1007/s11882-023-01088-9

Neu im Fachgebiet HNO

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

Hörschwäche erhöht Demenzrisiko unabhängig von Beta-Amyloid

29.05.2024 Hörstörungen Nachrichten

Hört jemand im Alter schlecht, nimmt das Hirn- und Hippocampusvolumen besonders schnell ab, was auch mit einem beschleunigten kognitiven Abbau einhergeht. Und diese Prozesse scheinen sich unabhängig von der Amyloidablagerung zu ereignen.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

16.05.2024 Pädiatrische Allergologie Nachrichten

Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Autoimmune Inflammatory Eye Disease: Demystifying Clinical Presentations for the Internist

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet HNO

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

Hörschwäche erhöht Demenzrisiko unabhängig von Beta-Amyloid

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

Update HNO

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2023

The Impact of Air Pollution on Atopic Dermatitis

Environmental Exposure to Foods as a Risk Factor for Food Allergy

Allergies Come Clean: The Role of Detergents in Epithelial Barrier Dysfunction

The Use and Teaching of Telemedicine in Allergy/Immunology Training Programs

The Impact of Climate Change on Asthma and Allergic-Immunologic Disease

Neu im Fachgebiet HNO

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

Hörschwäche erhöht Demenzrisiko unabhängig von Beta-Amyloid

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

Update HNO