Present status of corticotropin; ACTH, cortisone, and hydrocortisone in ophthalmology.

IN previous communications (Gordon and McLean, 1950; McLean and others, 1951; Gordon and others, 1951) this group has reported its experiences in the treatment of ocular disease with the use of corticotropin (ACTH) and cortisone. The present paper summarizes our knowledge of the clinical use of corticotropin and cortisone in ophthalmology and adds experiences with hydrocortisone during the past year. Nearly 3 years have elapsed since the introduction of these hormones into the ophthalmic armamentarium, but acquaintance with their uses, abuses, and limitations is not yet universal. Most ophthalmologists have had experience with the topical application of cortisone in drops or as an ointment, and many have used it systemically by intramuscular injection and orally in tablet form, but comparatively few have employed corticotropin. Too many physicians are still afraid to use corticotropin, or even cortisone by injection; but they occasionally use cortisone orally because they have the naive belief that anything given by mouth cannot be very dangerous. A recent survey conducted for one of the manufacturers ¢ by an independent testing company indicates that only 2 per cent. of ophthalmologists are familiar with the use of corticotropin. Even allowing for a great error in this analysis the final percentage would remain relatively small. One of the chief reasons for not using this potent hormone is the fear of the side-effects which systemic medication may produce. This same fear has undoubtedly militated against the use of cortisone systemically where systemic therapy has been indicated; or has resulted in the use of inadequate doses. It is unfortunate that the therapeutic horizon of too many ophthalmologists ends with the use of cortisone by topical application. While the topical applications of cortisone are very efficient, where indicated, they are equally impotent where not indicated, and an excellent mode of therapy may be discredited by improper use. The use of cortisone topically as the primary procedure in treating super-. ficial ocular disease is usually highly efficient. Cortisone drops or ointments are at times valuable in the initial treatment of uveitis, but one cannot count