Normal gradeComment
Bulbar redness Aetiology Dilation of bulbar vessels, e.g. due to mechanical stimulation, allergy/hypersensitivity etc
Up to grade 2Useful to evaluate using the same magnification each time
Normal gradeComment
Tarsal redness Aetiology Dilation of tarsal vessels, e.g. due to preservatives in lens care products, ocular dryness, mechanical irritation etc
Up to grade 2Roughness of the tarsal conjunctiva increases in higher grades
GRADE 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4
Normal gradeComment
Limbal redness Aetiology Dilation of bulbar vessels, e.g. due to hypoxia
Up to grade 2Often seen in combination with bulbar redness
AetiologyNormal gradeComment
Corneal neovascularisationPrimarily due to corneal hypoxiaGrade 0Classification based on the extent of blood vessel ingrowth
0 mm < 1 mm 1 - 1,5 mm 1,5 - 2 mm > 2 mm
Corneal staining: DessicationAetiologyNormal gradeComment
Superficial cells of the corneal epithelium become damagedGrade 0. Grade 1 may be a normal consequence of an incomplete blinkStain with fluorescein, view with blue light and a yellow filter
in Puurs, CPAK production site
IN PUURS, CPAK PRODUCTION SITE
IN PUURS, CPAK PRODUCTION SITE
Contact Lenses Grading Scales
14082-Alcon-GRADING-SCALES-2PP.indd 1 11/07/2019 04:29
Defining locations on the cornea Defining locations on the tarsal conjunctiva
Striae and folds in Descemet’s membrane
0 % corneal oedema: no striae5 % corneal oedema: very few striae7 % corneal oedema: more striae12 % corneal oedema: striae and folds16 % corneal oedema: striae, folds, microcysts and vacuoles
Microcysts and vacuoles
Practice orientated
C – central S – superiorI – inferiorN – nasalT – temporal
Scientific/research
P – para-central C – central S – superiorI – inferiorN – nasalT – temporal
Purpose Describing/documenting the corneal location of a slit lamp finding
Indication Infiltrates, staining, foreign bodies etc
Purpose To grade tarsal slit lamp findings exactly if there are local differences
Indication Papillae, foreign body, redness/hyperaemia, follicles etc
Purpose Indicative of corneal oedema, e.g. due to hypoxia
Indication No folds. Some striae may be visible immediately following waking
Comment Document the size, location, orientation and number
Purpose Indicative of chronic hypoxic stress
Indication No microcysts or vacuoles
Comment High magnification, monitor in the reflected light, note the quantity
GRADE 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4
© 2018 JENVIS RESEARCH. DEVELOPED BY SICKENBERGER, et al. © 2019 Alcon. 07/19 GB-VC-190007
1. von Ahrentschildt, A., Wittekind, J., Marx S., Sickenberger W. Comparative study of two grading scales for the evaluation of IR-meibography images of the upper and lower eyelid in terms of intra- and interrater reliability. 2018 American Academy of Optometry (peer reviewed poster session). 2. Arita, R., Itoh, K., Inoue, K., Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology, 2008. 115(5), 911-915.
www.jenvis-research.com
Vacuoles (display unreversed illumination)
Microcysts (display reversed illumination)
*JENVIS MEIBOSCORE according to Arita et al2.
No loss Loss <33% of analysed area
33% - 67% loss of analysed area
>67% loss of analysed area
GRADE 0 GRADE 1 GRADE 2 GRADE 3
AetiologyNormal gradeComment
Degeneration and Dysfunction of Meibomian Glands (MG) through disorder of secretion and morphological changesAge related. Normal grade in young patients 0-1, in elderly population up to 50% loss possibleIn addition to loss of MG, quality and expressibility of secretion should be assessed
MEIBOSCORE*1 (upper and lower lid)
AetiologyNormal gradeComment
SICS – Solution induced corneal stainingToxic reaction to contact lens solutionGrade 0Stain with fluorescein, view with blue light and a yellow filter. Consider changing the solution type
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IN PUURS, CPAK PRODUCTION SITE
IN PUURS, CPAK PRODUCTION SITE
14082-Alcon-GRADING-SCALES-2PP.indd 2 11/07/2019 04:29