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- Ocular Autoimmune Uveitis
Ocular autoimmune uveitis represents a diverse spectrum of inflammatory diseases. Protheragen provides end-to-end solutions for the diagnostic and therapeutic development of ocular autoimmune uveitis.
Ocular autoimmune uveitis (AU) is a type of intraocular inflammation with a broad spectrum of clinical manifestations affecting the uvea, or uveal tract of the eye which comprises the iris, ciliary body, and the choroid. If not medically treated, this disorder may escalate towards perpetual blindness and eyesight troubles. AU is known to be highly diverse, with most cases being idiopathic, while the rest of the AU cases are linked to systemic autoimmune diseases. Symptoms are also diverse, ranging from absence of symptoms at all to biologically rapid progression towards sight-threatening conditions based on the level of inflammation (anterior, intermediate, posterior, or panuveitis).
Fig.1 JAK inhibitors and mimetics show promise in treating autoimmune disorders like uveitis. (Pandey R., et al., 2023)
Anterior uveitis, the most prevalent subgroup of uveitis, describes intraocular inflammation largely restricted to the anterior uveal tract (iris and ciliary body), with causes ranging from autoimmunity and infection to trauma and iatrogenic injury. Iritis, inflammation localized exclusively to the iris, is its major subtype and accounts for roughly half of all uveitis cases; it can stem from ocular autoimmune uveitis or be triggered by infections, trauma, or medical interventions, and presents acutely or chronically with typical symptoms of painful red eye, photophobia and tearing.
| Subtypes | Main Involved Tissue | Typical Clinical Manifestations | Representative Etiology |
| Iritis | Iris only | Ocular pain, photophobia, ciliary flush; risk of posterior synechiae | Autoimmune-associated (HLA-B27, ankylosing spondylitis, sarcoidosis); infectious (herpes, toxoplasmosis); trauma |
| Iridocyclitis | Iris + ciliary body | Pain, photophobia, aqueous flare & cells; higher risk of synechiae formation | Autoimmune uveitis, infectious intraocular |
Persistent or recurrent intraocular inflammation from autoimmune uveitis can trigger multiple intraocular complications, among which posterior synechiae is a key anterior‑segment complication. Posterior Synechiae describes pathological abnormal adhesion of iris tissue to the anterior capsule of lens. Inflammatory mediators inside anterior chamber promote fibrinogen release, fibrin clot formation and fibroblast proliferation, driving iris‑lens‑capsule adhesion; elevated protein concentration in aqueous humor greatly increases synechiae risk. When adhesions encircle the full pupil circumference, iris bombé occurs and blocks aqueous humor outflow, further inducing pupillary‑block secondary glaucoma. Severe or chronic anterior‑segment inflammation (e.g., iritis) is the primary driver for posterior synechiae formation. Other common complications include complicated cataract, macular edema, elevated intraocular pressure / secondary glaucoma, and peripheral anterior synechiae.
Fig.2 Technique called retroiridian staining and synechiolysis for posterior synechiae research. (Alza A. G., 2024)Laboratory Tests
Laboratory tests are essential for detecting systemic autoimmune disorders or infections that may present with uveitis. Autoimmune serology—including rheumatoid factor, anti-CCP, and ANCA—can help identify systemic diseases. Genetic testing, such as HLA typing for uveitis and HLA‑B51 for Behçet's disease, is also important. Screening for pathogens like Toxoplasma, Treponema, Mycobacteria, Borrelia, and certain viruses is mandatory in infectious uveitis. For iritis-predominant cases, HLA‑B27 genotyping, CBC, CRP, and ESR are commonly used to differentiate autoimmune from infectious etiologies.
Imaging Techniques
Modern imaging modalities are essential in the process of diagnosis. With optical coherence tomography, it is possible to obtain intricate images of the retinal layers aiding in the diagnosis of macular edema and other retinal pathologies. Fluorescein angiography helps to study the retinal and choroidal circulation and helps to identify regions of hemorrhage and ischemia. Ultrasound biomicroscopy assists in the examination of structures in the anterior segment, especially with anterior uveitis, and can visualize posterior synechiae adhesions within the anterior chamber.
Table 1. Therapeutics of autoimmune uveitis. (Prete M., et al., 2016)
| Therapeutics | Target | Description | Stage |
| Corticosteroids | NF-κB signaling, TLR2/TLR4, activated CD4+ T cells | First-line therapy for active AU; reduces inflammation. Administered topically, periocularly, or systemically. | Approved |
| Cyclophosphamide | NF-κB signaling, CD4+ T cells | Used for severe or refractory AU; effective but associated with side effects like leukopenia and cystitis. | Approved |
| Methotrexate | T cells, B cells | Second-line immunosuppressant; steroid-sparing agent with a good safety profile. | Approved |
| Azathioprine | T cells, B cells | Third-line therapy; is used for chronic AU, especially in juvenile idiopathic arthritis. | Approved |
| Cyclosporin A | NFAT (nuclear factor of activated T cells) | Second-line therapy; inhibits T-cell activation but may cause renal toxicity and hypertension. | Approved |
| Mycophenolate Mofetil | T cells, B cells | Third-line therapy; is effective for controlling inflammation with fewer side effects compared to cyclophosphamide. | Approved |
| Tacrolimus | NFAT | Similar to cyclosporin A but more potent; used in refractory cases. | Approved |
| Infliximab | TNF-α | Anti-TNF-α monoclonal antibody; highly effective in Behçet's disease and refractory AU but may cause infusion reactions. | Approved |
| Adalimumab | TNF-α | Subcutaneous anti-TNF-α therapy; safer than infliximab, used in pediatric and adult AU. | Approved |
| Atropine | Iris Sphincter Muscle | Cycloplegic agent; dilates pupil to prevent or break posterior synechiae in anterior-segment inflammation. | Approved |
| Phenylephrine | Iris Radial Muscle | Sympathomimetic mydriatic; combined with cycloplegics for synechiae management. | Approved |
| Beta-Blockers | Intraocular Pressure | Manage elevated intraocular pressure secondary to synechiae-induced glaucoma, without aggravating intraocular inflammation. | Approved |
Disclaimer: Protheragen focuses on providing preclinical research service. This table is for information exchange purposes only. This table is not a treatment plan recommendation. For guidance on treatment options, please visit a regular hospital.
Protheragen's expertise spans from early-stage research to preclinical development, providing a full spectrum of solutions tailored to meet the unique challenges of this complex disease. Our diagnostics development services include the design and validation of assays for autoimmune markers, genetic testing, and advanced imaging techniques. In the therapeutic realm, we specialize in the development of targeted drugs, biological agents, and innovative delivery systems to ensure optimal efficacy and safety.
Understanding that each client's needs are unique, Protheragen provides customized services tailored to specific research and development goals. If you are interested in our services, please feel free to contact us.
References
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As a research service provider, Protheragen offers a comprehensive range of cutting-edge services to advance the development of innovative therapies and unlock the future of rare eye disease therapeutics.
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