Immunology of the Eye Flashcards

(37 cards)

1
Q

what is the innate immune system

A

first line defence - rapid response (mins-hours)
physical barrier

targets groups of pathogens
no memory
targets a limited number of bacterial structures

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2
Q

what is the adaptive immune system

A

acquired, learned, specific immunity

takes days

has memory -allows you to build tolerance to pathogen if you encounter it again

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3
Q

what are the innate immune features of the eye

A

chemical agents and immune cells

no skin barrier and few commensals

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4
Q

how does the eye protect itself (first line)

A

blink reflex - tears
Lysozyme on the eye surface (plus lots of other anti-bacterial properties)
Limit exposure/size

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5
Q

what layers does the tear film have

A

lipid layer
aqueous layer
mucin layer - anti-adhesive

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6
Q

what anti-microbial properties do the tears have

A
lysozyme (destroys cell walls) 
lactoferrin and transferrin 
antibacterial lipids 
angiogenin 
IgA 
complement 
IL6, IL8, MIP
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7
Q

what immune cells are in the tears

A

neutrophils
macrophages
conjunctival cells

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8
Q

what does the adaptive immune system require to work

A
  1. Antigen presenting cells
  2. lymphatic drainage to lymph nodes
  3. variety of effector cells (CD4+, CD8+ T cells, B cells)
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9
Q

what are the principle APCs for the external eye

A

Langerhans cells (rich in class II MHC molecules)

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10
Q

where are most langerhans cells found

A

at the cornea-scleral limbus - less in the peripheral cornea and ABSENT in the central 1/3 of the cornea

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11
Q

what part of the eye is the only part with lymphatic drainage

A

conjunctiva

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12
Q

what immune features are found in conjunctival zones

A
dendritic cells 
mucosa associated lymphoid tissue 
macrophages 
langerhans cells 
mast cells 
commensal bacteria
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13
Q

are the cornea and sclera avascular/vascular

A

avascular

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14
Q

what section of the cornea contains langerhans cells

A

peripheral cornea

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15
Q

the sclera and cornea have a normal immune environment true/false

A

false

a down regulated immune environment

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16
Q

what immune features are seen in the lacrimal gland

A
plasma cells (IgA) 
CD8+ T cells
17
Q

what protects the vitreous compartment, choroid and retina from infection

A

blood-ocular barrier
Lack of APCs
Down regulated immune environment (to prevent collateral damage from immune responses)

18
Q

why is the immune environment in the eye down regulated

A

because there is potential for a lot of collateral damage from inflammation

19
Q

What is immune privilege

A

an active process where parts of the body are able to tolerate the introduction of antigens without eliciting an inflammatory immune response

20
Q

what sites in the eye are immune-privileged

A
cornea 
anterior chamber 
lens 
vitreous cavity 
sub retinal space
21
Q

how is ocular immune privilege established

A

separation: cornea is separated from immune system by lack of blood and lymphatic vessels
inhibition: development of an intraocular immunosuppressive environment
regulation: peripheral tolerance to ocular antigens (ACAID)

22
Q

what is anterior chamber associated immune deviation (ACAID)

A

if a pathogen gets into the anterior chamber, peripheral tolerance to the antigen occurs

  • suppressed a future potentially damaging response to infection
23
Q

what is sympathetic ophthalmia

A

rare bilateral granulomatous uveitis due to trauma or surgery to 1 eye

(secondary development of autoimmune reaction to ocular antigens exposed during trauma)

Disadvantage of immune privilege - related to the immune isolation of the eye

24
Q

what are the primary mediators in sympathetic ophthalmia

25
what is the injured eye called in sympathetic ophthalmia
exciting eye | other eye is the sympathising eye- can only tell the difference from history
26
what are some side effects of a defective/absent immune system
``` recurrent (severe) infections ignores innocuous substances tolerance to self acceptance of transplanted organs/tissues cancer ```
27
what are the side effects of a hyperactive immune system
protection from harmful pathogens responds to innocuous substances responds to self rejection of transplanted organs/tissues
28
what is a type 1 hypersensitivity reaction
ALLERGIC RESPONSE B cells encounter allergens so produces IgE - clears allergen mast cells bind to the left over IgE which wasn't cleared this means next time the pathogen is encountered, because the IgE is already attach to the mast cells it immediately reacts to the pathogen mast cells release loads of inflammatory mediators
29
what is an example of a type 1 hypersensitivity reaction in the eye
acute allergic conjunctivitis
30
what is a type 2 hypersensitivity reaction
direct killing/antibody response The pathogen is killed by either Macrophages/NK cells or complement
31
what is an example of a type 2 hypersensitivity reaction in the eye
ocular cicatrical pemphigoid | type of autoimmune conjunctivitis: blistering and scarring of the conjunctiva
32
what is type 3 hypersensitivity
Immune complex mediated Immune system produces too much antibody and the complexes can't get cleared leading to inflammation
33
example of type 3 hypersensitivity in the eye
Autoimmune corneal melting
34
what is type 4 hypersensitivity
delayed type complex reactions which take a long time to come about but are v adapted clonal expansion of T cells lead to an exaggerated immune response
35
example of type 4 hypersensitivity reactions in the eye
corneal graft rejection
36
what factors in the eye help maintain immune privilege
reduced and impaired expression of MHC I and II molecules in cornea cornea lacks blood and lymph vessels Central cornea is deficient in lagerhands secretion of molecules with immunosuppressive properties inhibits immune cells expression of surface molecules to inhibit immune effectors ACAID in the peripheral immune system
37
side effects of steroids in the eye
cataracts | steroid-induced glaucoma