Episcleritis and scleritis. A study of their clinical manifestations and association with rheumatoid arthritis.

Sir William Read, Royal Ophthalmologist during the reign of Queen Anne (1702-17I4), who inci- dentally was unable to read or write (Guthrie, 1958), gave a choice description of the dangers of perforation in deep scleritis: 'For it is most certain that this horny membrane . . .by how much deeper the blister is hidden in the membrane . . . in danger to make an ulceration by breaking through the membrane, whereupon may ensue an utter loss and decay of all the humours'.Further documentation of the sequelae of scleral inflamma- tion awaited a further century for the description of staphylomata by Scarpa (i8i8), who described two cases of posterior staphylomata found at necropsy.Mackenzie (I830) attributed scleritis to atmospheric conditions and suggested the term 'sclerotitis atmos- pherica' or 'rheumatic ophthalmia'.Later Macken- zie (I854) was to suggest the name 'sclerotitis idio- pathica'.Wolfe (I882), lecturing to the students of Anderson College, Glasgow, used the currently accepted nomenclature of episcleritis and scleritis.The later terminology has been excellently recorded by Sevel (I967).Earlier authors often associated inflammation of the sclera with rheumatic disease (Mackenzie, I830; Littell, I840; Wolfe, I882; von Arlt, i885).Besides 'rheumatism', scleritis was attributed to gout (Cleobury, i826; Walton, I875), mercury poisoning (Morgan, I839), venereal disease, parti- cularly syphilis (Morgan, I839; von Arlt, I885); scrofula (Mackenzie, I854); excessive exposure to varying atmospheric conditions (Mackenzie, I830; de Schweinitz, I899), and menstrual derangement (de Schweinitz, I899).The most consistent systemic disorder associated with episcleritis and scleritis, particularly the latter, is rheumatoid arthritis (Van der Hoeve, 1934;