[Application of current immunological knowledge in ocular therapy]

Specific treatment of ocular and orbital inflammations requires precise knowledge of the immune processes involved. The encounter between the host and an antigenic stimulus initially induces the inflammatory response, whose numerous mediators (complement, lipid derivates, histamine etc.) should lead to phagocytosis and elimination of the antigen. If this first line of resistance fails, the immune response follows, mediated by T and B lymphocytes and immunoglobulins. Complex interactions between cells and released substances permit selective activation of cell clones specific to the causative antigen. Some of these inflammatory and immune mechanisms have been identified in the pathogenesis of various forms of uveitis and orbital inflammation. Such knowledge makes specific therapy possible, for instance with antiprostaglandins or other inhibitors of the processes involved. Most cases of uveitis, however, have their origin in a local hyper-function of the immune response and therefore benefit from immunosuppression (steroids, cytostatics, Cyclosporin-A). Immunostimulation can be useful in cases with certified immunodeficiency.