Double-blind trial of the treatment of episcleritis-scleritis with oxyphenbutazone or prednisolone.

THE clinical impression of one of us (D.W.S.) that oxyphenbutazone (Tanderil) had a markedly beneficial effect on episcleritis gained some confirmation by the short report of Bannerjee and Taylor (1961). It was therefore decided to carry out a controlled double-blind trial. The object of this trial was to assess the comparative value of oxyphenbutazone as an alternative to prednisolone in the treatment of scleritis and episcleritis in patients in whom systemic treatment was indicated. In addition, it was hoped that some light could be shed on the diagnosis and aetiology of this group of diseases. Inflammation of the episclera without involvement of the underlying sclera is termed episcleritis. Two types are generally recognized, simple episcleritis (including episcleritis periodica fugax) and nodular episcleritis (Fuchs, 1895; Schirmer, 1895; Duke-Elder, 1938). Simple episcleritis is a disease of young or middle-aged adults characterized by diffuse congestion, with or without oedema of the episclera, accompanied by local pain and headache. Simple episcleritis often recurs at regular intervals and there may be a family history of the complaint. Although there may be no visible residium after each attack, this type of episcleritis is said to progress after many attacks to a scleritis or sclerokeratitis (Duke-Elder, 1938). Nodules can occur in the episclera in gout, tuberculosis, syphilis, zoster, and other conditions, including metastatic pyogenic infections. Most frequently, no aetiological factor can be found and the condition is then described as nodular episcleritis, a recurrent disease found especially in the middle-aged or elderly (Duke-Elder, 1938). It is characterized by the appearance in the episclera of nodules surrounded by haloes of injected episcleral vessels, and occasionally the overlying conjunctival vessels are injected. Nodular episcleritis is usually a benign condition which does not progress to scleritis. Scleritis may have nodules associated with it but this does not mean that the condition started as a nodular episcleritis (Swan, 1951). Scleritis is a severe disease and can ultimately be blinding. It causes severe pain and headache; many eyes are removed for intractable pain. It is usually subdivided, according to the site involved, into sclerokeratitis, anterior and posterior scleritis. If the inflammation is very severe with pitting oedema of the overlying episclera, it is termed brawny scleritis. It is almost always accompanied by an anterior or posterior uveitis. It is most often associated with rheumatoid arthritis, polyarteritis nodosa, or Wegener's granulomatosis. Rheumatic nodules in the sclera