Sir,

We read with interest the recent paper by Boonman et al,1 which reported a delay in response to treatment of scleritis in smokers compared with that in non-smokers. The authors postulated pharmacological and immunological reasons that may explain this. One explanation that they did not address is different rates of treatment compliance between the two groups.

This is an important consideration as smoking has been shown to be a predictor of poor compliance with treatment in a diverse range of conditions including acne,2 renal failure,3 epilepsy,4 and hyperlipidaemia.5