From the earliest available descriptions of episcleritis (Slade, 1838; Rognetta, i844; Desmarres, 1847) a confusion has existed between scleritis and episcleritis. This has led to contradictory views on the relative severity and prognosis of these conditions, and the erroneous belief that episcleritis is accompanied by serious complications (Viswalingham, 1936;Wood, 1936; Mann and Markson, I950;Clavel and Teulieres, 1958). While Slade (I838), Rognetta (i844), and Desmarres (I847), thought that episcleritis was both common and severe, Mackenzie (i 830) considered it to be neither and gave at the same time a vivid and accurate description of scleritis. This confusion still persists today.In an attempt to clarify the position we have been studying patients with scleritis and episcleritis in a special clinic at Moorfields Eye Hospital during the past io years. Of these, 207 patients (30I eyes) with episcleritis and 159 patients (2I7 eyes) with scleritis were analysed in depth. § The results reported below have led us to conclude that scleritis and episcleritis are clinically distinct, with a different symptomatology and prognosis and requiring different management.The incidence of these conditions is not known, but Williamson (1974)

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The clinical features, treatment, and visual outcome of 52 eyes from 43 patients who developed scleritis following surgery were reviewed. In all patients the scleral inflammation developed adjacent to a surgical wound. Ninety six per cent had necrotising disease and 23% also had evidence of secondary posterior scleritis. Many different types of ocular surgery were implicated and the majority (75%) of the patients had two or more surgical procedures before the onset of the scleritis. Although cataract extraction through a limbal incision resulted in the largest subgroup, scleritis also followed glaucoma, strabismus, and retinal detachment surgery. The latent period between surgery and the appearance of inflammation was short (mean 9 months) except for a small group in whom scleritis occurred many years after squint surgery. Sixty three per cent ofpatients had evidence of a systemic disease. Early diagnosis and aggressive medical treatment significantly improved the visual outcome. The precipitating factors, pathogenesis, and course of this condition are discussed.

SummaryThe complications of trabeculectomy were studied in two groups of patients taken from a stable white population. The first group who had had their operation when it was first introduced 22 years ago, had been previously treated with prolonged medi cation, the second group had been operated upon recently and had had short-term pre-operative medication. This study confirmed that trabeculectomy predictably reduces the intraocular pressure to within the accepted normal range and that the pressure level below which the intraocular pressure could not be expected to fall was £: 14 mm/Hg. It also revealed that although some post operative abnormality was noted in two-thirds of the patients there were no long term problems which could be related to any operative or immediately post-operative complications, including shallow anterior chambers, uveitis and hyphaema. However, there was a long term reduction in the visual acuity and visual fields of about one-third of the patients, which was not related to cataract formation, macular problems, the height of the preoperative intraocular pressure, the amount by which this fell as a result of the surgery, or the amount, length or type of preoperative medication given before the operation. Although there was some increase in cataracts throughout the whole long term group this was mainly in those who had cataract prior to surgery; the increase was not related to operations or any other factor other than corneo-Ienticular contact post-operatively.

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