Immunopathology of scleritis

Ophthalmology. 1991 Apr;98(4):472-9. doi: 10.1016/s0161-6420(91)32280-2.


Conjunctival and scleral biopsies from 25 patients with necrotizing scleritis and 5 patients with recurrent nonnecrotizing scleritis were studied by histopathologic, immunofluorescence, and immunoperoxidase techniques. Vasculitis with fibrinoid necrosis and neutrophil invasion of the vessel wall was present in 75% of the scleral and 52% of the conjunctival specimens. Vascular immunodeposits were found in 93% of the scleral and 79% of the conjunctival tissue tested by immunofluorescence techniques. A dramatic increase in the number of inflammatory cells over normal controls was detected in both tissues by immunoperoxidase techniques. In the conjunctival epithelium, there were significantly more T-helpers, macrophages, and B cells. In the conjunctival substantia propria, there were significantly more T cells of all types, macrophages, and B cells. Likewise, scleral specimens showed an increase over controls of T cells of all types and macrophages. HLA-DR expression was dramatically increased in both tissues. Immune-complex-mediated vasculitis plays a pivotal role in the pathogenesis of necrotizing scleritis and recurrent nonnecrotizing scleritis. Induced HLA-DR expression on ocular nonimmune cells and T cell controlled responses also may participate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antigen-Antibody Complex / immunology
  • Autoimmune Diseases / pathology
  • B-Lymphocytes / immunology
  • Biopsy
  • Conjunctiva / immunology*
  • Conjunctiva / pathology
  • Female
  • Fluorescent Antibody Technique
  • HLA-DR Antigens / immunology
  • Humans
  • Immunoenzyme Techniques
  • Macrophages / immunology
  • Male
  • Middle Aged
  • Sclera / immunology*
  • Sclera / pathology
  • Scleritis / immunology*
  • Scleritis / pathology
  • T-Lymphocytes / immunology
  • T-Lymphocytes, Helper-Inducer / immunology


  • Antigen-Antibody Complex
  • HLA-DR Antigens