Treatment of scleritis and episcleritis

A double blind trial showed that prednisolone sodium phosphate or betamethasone 21 disodium phosphate drops or oxyphenbutazone ointment increased the rapidity of healing in episcleritis, which is however usually selfhealing in 21 days. Systemic treatment is necessary for scleritis. A minimum of 40 mg of prednisolone daily is required and sometimes 60 or even 120 mgms. Preliminary results of a double blind trial indicate that systemic doses of 100 mgm of oxyphenbutazone, 6 times daily reduced to 4 times daily after 4 days, and indomethacin 25 mg, 3 or 4 times daily, are therapeutically effective. Like the cytotoxic immunosuppressive agents, penicillamine should only be used if other forms of treatment fail as side effects are frequent. Local steroid may be given as drops, but should not be injected subconjunctivally as this may precipitate scleral perforation. Biopsy is also contraindicated as the site usually fails to heal. (Somerset - Harrogate)