Auto-immunity in Uveitis.

Since the discovery that auto-antibodies to thyroglobulin were present in cases of Hashimoto's disease (Doniach and Roitt, 1957), a search for auto-antibodies has been made in various diseases of otherwise obscure origin. Ophthalmology has already provided the first confirmed example of an auto-antibody causing disease in the condition endophthalmitis phako-anaphylactica; a similar explanation has been advanced in the case of sympathetic ophthalmitis (Woods, 1917). Although there are many known causes of endogenous uveitis, there remains a large group of cases in which no direct infective cause has been demonstrated and in which the aetiology is obscure. This group of cases is typified by the acute anterior uveitis in adults which is usually considered as a manifestation of uveal hypersensitivity. Auto-immunity to uveal tissue, perhaps following alteration of its antigenic status by circulating toxins of bacterial orgin, would provide a satisfactory explanation of the clinical findings. It must be emphasized, however, that the demonstration of circulating antibodies to a tissue is not a proof of auto-immune disease as the cause of the condition. It is quite likely that, in any disease in which breakdown of tissue occurs, some antibodies to this tissue might be produced as a secondary process following the original insult-traumatic, infective, etc. Disturbances in serum gamma-globulin have been reported in uveitis (Woods and Stone, 1958), although no consistent pattern could be recognized-this suggests an immunological basis for some types of uveitis; but the only direct evidence of auto-antibodies to uveal tissue apart from cases of sympathetic ophthalmitis has been the report of Hallett, Wolkowicz, Leopold, Canamucio, and Wijewski (1962). They performed complement-fixation tests, using uveal tissue, kidney, and liver as antigen, on the sera from normal individuals, patients with uveitis, and patients suffering from other ocular conditions. Positive results were obtained in less than 10 per cent. of the normal sera, in about 52 per cent. of the uveitis group, and in about 32 per cent. of the group with other ocular diseases. There was no predominance of positive results in any one type of uveitis and the occurrence of 32 per cent. positive results in other eye diseases raises doubt concerning the specificity of the test. The authors suggest that there may be other hitherto unrecognized instances of auto-immune ocular disease accounting for the results in ocular diseases other than uveitis. We have attempted to find evidence of auto-immune antibodies in the sera of uveitis patients, using the complement-fixation test and fluorescent antibody method.