Ocular surface inflammation is regulated by innate immunity

On the ocular surface, as in the intestines and airway, the surface epithelium serves a critical function as the front-line defense of the mucosal innate immune system. Although the detection of microbes is arguably the most important task of the immune system, an exaggerated epithelial host defense reaction to endogenous bacteria may initiate and perpetuate inflammatory mucosal responses. In this review we first describe commensal bacteria found on the ocular surface, which is in contact with the ocular surface epithelium. We also discuss the innate immunity of the ocular surface epithelium and we present the allergic reaction regulated by ocular surface epithelial cells. We address ocular surface inflammation due to disordered innate immunity and we present our hypothesis that the onset of Stevens-Johnson syndrome (SJS) with severe ocular surface complications, a devastating ocular surface inflammatory disease, is strongly associated with abnormality of the innate immune system. In this review we raise the possibility that some ocular surface inflammatory diseases are pathogenetically related with a disordered innate immune response. Focusing on the innate immunity of the ocular surface might help to elucidate the pathogenesis of various ocular surface diseases.