Immunol Allergy Clin N Am

28 (2008) xiii

Dedication

To the memories of my father, Max Bielory; my father-in-law, Daniel Gilan; and my brother, Charles Bielory.

0889-8561/08/$ - see front matter 2008 Elsevier Inc. All rights reserved.

Immunol Allergy Clin N Am

28 (2008) ix–x

Foreword

When My Eyes Tear

Rafeul Alam, MD, PhD

Consulting Editor

When my eyes tear, I should be sad, but I am not. I am actually irritated because I know my allergies are back. Allergic disorders of the eyes are a common manifestation of environmental allergies and are frequently under-diagnosed. Although the pathophysiology of ocular allergies has many elements that are common to allergic disorders of other organs, there are eye-specific elements that cannot be overemphasized. The importance of Th2 to ocular allergic inflammation is well known. However, the contribution of Th1 cells and their mediators are being increasingly recognized. In this context, it would be interesting to know the role of Th17 and Treg cells in ocular allergic inflammation. The allergen challenge of the eyes and measurement of inflammatory mediators in the tear have produced a wealth of data that has increased our knowledge about the pathophysiology of ocular allergies. Further, the development of an animal model of allergic conjunctivitis has allowed the application of novel investigational approaches as well as the testing of various therapeutic modalities.

To update our readership with the latest progress in ocular allergy, Dr. Leonard Bielory, a recognized leader in the field, has invited an outstanding group of experts. The topics of this issue include not only immunologic disorders of the eyes but also ocular manifestation of dermatologic

0889-8561/08/$ - see front matter 2008 Elsevier Inc. All rights reserved.

disorders. This update will benefit practicing clinicians from the field of allergy-immunology as well as ophthalmology.

Rafeul Alam, MD, PhD

Division of Allergy and Immunology

National Jewish Medical and Research Center

University of Colorado Health Sciences Center

1400 Jackson Street

Denver, CO 80206, USA

E-mail address: AlamR@njc.org

Immunol Allergy Clin N Am

28 (2008) xi–xii

Preface

Leonard Bielory, MD

Guest Editor

The eye is probably the most common site for the development of allergic inflammatory disorders, since it has no mechanical barrier to prevent the impact of allergens such as pollen on its surface. Allergists/clinical immunologists frequently encounter various forms of allergic diseases of the eye that present as ‘‘red eyes’’ in their referral practice. However, the eye is rarely the only target for an immediate allergic-type response. Typically, many patients have other combinations of allergic disorders, such as rhinoconjunctivitis, rhinosinusitis, asthma, urticaria, or eczema; there also exists a systemic allergic component. Even so, ocular signs and symptoms can frequently be the most prominent features of the entire allergic response for which these patients come to see their physician.

The treatment of ocular inflammation is perhaps unique in medicine because it initially involved the combination of complex surgical procedures with simple medical management commonly provided by a single medical specialist, the ophthalmologist. The advances in understanding the immunopathophysiology of many ocular disorders have generated the need for a multidisciplinary approach involving various specialists who would cooperatively work together to control inflammation with systemically, topically, or intraocularly therapeutic agents. Over the past 20 years, we have witnessed an astonishing growth in therapeutic advances, ranging essentially from derivatives of simple aspirin to various newly developed biologic immunomodulatory agents, utilizing implantable drug delivery devices that exceed the safety and e cacy of those available for other organ systems, and

0889-8561/08/$ - see front matter 2008 Elsevier Inc. All rights reserved.

resorting to advanced surgical techniques for the correction of sight-threat- ening, disease-related complications.

The small compartment that the eye resides in has been commonly considered a disadvantage, but suddenly becomes a huge advantage. The eye itself is not lacking in immunologic complexity, as there appears to be an external conjunctival associated lymphoid tissue system and a paradoxical internal immune system that acts in a manner as a secluded immune compartment. Overall, with the expanding knowledge base, the intricacy of ocular inflammation appears to be becoming ever more manageable and, with the team approach between the ophthalmologist and the clinical allergist/immunologist, the new ‘‘immuno-ophthalmology’’ approach improves patient outcomes.

In this issue of Immunology and Allergy Clinics of North America, which focuses on ocular allergy, I have attempted to bring together various topics in anterior ocular inflammation in order to provide the allergist/clinical immunologist a better understanding and to become an active partner in the diagnosis and management of ocular inflammation of the anterior portion of the eye, primarily known as ‘‘conjunctivitis.’’

Acknowledgement

I would like to personally acknowledge Ms. Lynn Baltimore for her invaluable library assistance, and all of the authors for the dedicated e orts in making this issue a reality!

Leonard Bielory, MD

UMDNJ–New Jersey Medical School

90 Bergen Street

DOC Suite 4700

Newark, NJ 07103, USA

E-mail address: bielory@umdnj.edu