GRADING SCALES*

1. TRACE 2. MILD 3. MODERATE 4. SEVERE

BULBAR REDNESS

LIMBAL REDNESS

PALPEBRAL REDNESS

PALPEBRAL ROUGHNESS

CORNEAL STAINING - TYPE

MICROPUNCTATE MACROPUNCTATE COALESCENT PATCH

Available for download at

academy.brienholdenvision.org
 GRADING SCALES*

PALPEBRAL CONJUNCTIVAL GRADES

APPLICATION OF GRADING SCALES • The palpebral conjunctiva is divided into
five areas to grade redness and roughness.
• Patient management is based on how much the • Areas 1, 2 and 3 are most relevant in
contact lens wear.
normal ocular appearance has changed.

• In general, a rating of grade 2 or less is considered

within normal limits (except staining). CORNEAL STAINING GRADES
• Staining assessed immediately after single
• A change of one grade or more at follow up visits is instillation of fluorescein using cobalt blue
considered clinically significant. light and wratten 12 (yellow) filter over the
slit lamp objective.
• The cornea is divided into five areas.
The type of staining is graded in each area.

ADVERSE EFFECTS WITH CONTACT LENSES

CLPC CONTACT LENS PAPILLARY CONJUNCTIVITIS
EROSION
Inflammation of the upper palpebral conjunctiva.
Full thickness epithelial loss over a discrete area.
Signs
• Redness
Signs
• Enlarged papillae • No stromal inflammation
• Excess mucus • Immediate spread of fluorescein into stroma
Symptoms Symptoms
• Itchiness • Can be painful
• Mucus strands • Photophobia
• Lens mislocation • Lacrimation
• Intolerance to lenses

INFILTRATES CLPU CONTACT LENS PERIPHERAL ULCER

Accumulation of inflammatory cells in corneal sub-epithelial Round, full thickness epithelial loss with inflamed base, typically in the
stroma. Inset: high magnification view. corneal periphery which results in a scar. Insets: with fluorescein, scar.
Signs Signs
• Whitish opacity (focal) or grey haze • Unilateral, “white spot”, usually confined
(diffuse) to 2-3mm from limbus
• Localized redness • Localised redness
Symptoms • Infiltrates
• Asymptomatic or scratchy, foreign • Post healing scar
body sensation Symptoms
• Redness, tearing and photophobia • Varies from foreign body sensation to pain
possible • Lacrimation and photophobia may occur
MICROBIAL KERATITIS
CLARE CONTACT LENS ACUTE RED EYE Full thickness epithelial loss with stromal necrosis and inflammation,
An acute corneal inflammatory episode associated with sleeping in typically central or paracentral.
soft contact lenses. Signs
Signs • Intense redness
• Unilateral • “White patch” (raised edges)
• Intense redness • Infiltrates
• Infiltrates • Epithelial and stromal loss
• No epithelial break • Anterior chamber flare
Symptoms • Conjunctival and lid edema
• Wakes with irritation or pain Symptoms
• Photophobia • Pain, photophobia
• Lacrimation • Redness, mucoid discharge
•  VA (if over pupil)
POLYMEGETHISM
1. VERY SLIGHT 2. SLIGHT 3. MODERATE 4. SEVERE

VASCULARISATION STROMAL STRIAE and FOLDS MICROCYSTS and VACUOLES

Vessel One striae = 5% edema Located in epithelium.
extension One fold = 8% edema Identified by side
beyond (each additional striae showing brightness.
translucent or fold indicates 1% reversed
limbal zone more edema) Microcysts
is recorded
(mm). Vacuoles
unreversed
Record number observed Record number observed

© Copyright Brien Holden Vision Institute 1993 - 2017 *For guidance only
This document is provided “as is”, without any warranty as to its fitness for purpose, accuracy, or otherwise. Except as provided by law, the user bears all risk arising from any use of this document.