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8310048 
Journal Article 
Local and systemic cortisone in ocular disease 
Leopold, IH; Purnell, JE; Cannon, EJ; Steinmetz, CG; McDonald, PR 
1951 
Yes 
American Journal of Ophthalmology
ISSN: 0002-9394
EISSN: 1879-1891 
34 
3 
361-371 
English 
It is evident from these studies and others that: 1. 1. Subconjunctival administered cortisone may penetrate into the intraocular fluids in detectable quantities. Topically and retrobulbarly administered cortisone also produced detectable amounts in the intraocular fluids of rabbit eyes. A wetting-agent vehicle allowed greater penetration following drop application than a saline vehicle. 2. 2. Cortisone, when injected in the dosage used in this study into conjunctiva, retrobulbar tissue, and intraocularly, produced no irreparable damage. 3. 3. Cortisone interferes with fibroblast formation in the corneal stroma and with epithelial regeneration. Topical application did this less so than subconjunctival injection. 4. 4. Cortisone reduces inflammatory reactions not only of toxic substances and allergic reactions but also of experimental bacterial invasion, but not that of experimental virus lesions. 5. 5. Cortisone may have a specific antibacterial effect but most of this is probably due to its preservative benzyl alcohol. 6. 6. Local cortisone failed to decrease the permeability of the blood-aqueous barrier for fluorescein. This study does show that cortisone may be used as a solution for topical application diluted 1;4 with normal saline so that each cc. of solution contains approximately 6.0 mg. of cortisone. It may be used by subconjunctival injection, with 0.05 cc. of cortisone solution containing 1.25 mg. of cortisone. Subconjunctival injections should be continued until the eye is either definitely quiet or until no further improvement occurs with continued treatment. Relapses after subconjunctival therapy and systemic therapy can sometimes be prevented by subsequent topical therapy. One must realize that a certain reaction will occur with any subconjunctival injection and that cortisone remains subconjunctivally as a yellowish mass which will disappear within five to seven days after the injection. If retrobulbar cortisone is to be used, one should be prepared for unusual marked reactions of edema in occasional cases. The value of such form of therapy in retrobulbar neuritis and posterior uveitis is questionable. Systemic cortisone would appear, from this study, to have a greater effect in posterior uveitis than subconjunctival cortisone, and also in occasional cases of anterior uveitis. Wherever subconjunctival cortisone has failed, systemic cortisone may still be tried with some hope of benefit. A definite number of cases improved only while cortisone was being administered and another group improved for a while on cortisone therapy, but subsequently failed to benefit from repeated and continued therapy. At the present time, there does not seem to be any method by which the permanency of cortisone therapy can be predicted. © 1951.