Chronic infection with filarial nematodes results in development of a suppressive response to an immense parasite burden, thereby limiting pathological and clinical manifestations. However, pro-inflammatory responses to dead and degenerating Onchocerca volvulus worms and release of endosymbiotic Wolbachia bacteria result in corneal opacification, sacrification and visual impairment. This review discusses host and parasite factors implicated in maintaining this balance of pro- an anti-inflammatory responses, and will focus on adaptive and innate immunity to filarial antigens and endosymbiotic Wolbachia bacteria.