How red is a white eye? Clinical grading of normal conjunctival hyperaemia

Abstract

Purpose To quantify the level of normal bulbar conjunctival hyperaemia using the Cornea and Contact Lens Research Unit (CCLRU) grading scale, and to investigate inter-observer agreement. Methods Bulbar conjunctival hyperaemia was assessed by two trained observers, using the CCLRU grading scale (zero to four units) interpolated into 0.1 increments, on the right eye of 121 healthy, non-contact lens-wearing subjects (male ¼ 58, female ¼ 63, median age ¼ 28 years, range 16-77). The eye was observed using a slit-lamp bio-microscope ( Â 10 magnification) under diffuse, white illumination. The subject's position of gaze was directed to allow grading of four quadrants: superior, nasal, inferior, and temporal conjunctiva. Bulbar redness was defined as the average of those four grades of conjunctival hyperaemia. A further twenty subjects were recruited to assess interobserver agreement (male ¼ 8, female ¼ 12, median age ¼ 23 years). Results The average bulbar redness was 1.93 (70.32 SD) units. The nasal (2.370.4) and temporal (2.170.4) quadrants were significantly redder than the superior (1.670.4) and inferior (1.770.4) quadrants (Po0.0001). Males had redder eyes than females by 0.2 units. Inter-observer 95% limits of agreement for bulbar redness was 0.38 units. Conclusions The average bulbar redness of 1.9 units was higher than expected, reflecting the design of the grading scale. A bulbar redness of greater than 2.6 units may be considered abnormal, and a change in bulbar redness of Z0.4 units may be significant.

The relationship between clinical signs and dry eye symptoms

“…The bulbar hyperaemia median score (CCLRU 2.3) and limbal hyperaemia median scores (CCLRU 2.0) were slightly higher than published norms, but within normal confidence limits. 39,50 Median ocular staining of this cohort was at a normal level. 38,51,52 For LIPCOF, this is the first time that median scores have been reported in non-contact lens wearers (1/0/1 (temporal/nasal/Sum)), which is less than that reported in experienced soft contact lens wearers (2/0/2).…”

“…Limbal and bulbar hyperaemia of the horizontal segment of the ocular surface was evaluated by slit-lamp microscope using 12 Â magnification and classified using the CCLRU grading scale (University of New South Wales, Sydney, Australia), [38][39][40] interpolated in 0.1 increments.…”

“…[38][39][40] The fluorescein grading scale was used for both measures in the absence of a published recommendation for lissamine green staining.…”

Comparison of Corneal Safety and Intraocular Pressure–Lowering Effect of Tafluprost Ophthalmic Solution with Other Prostaglandin Ophthalmic Solutions

“…For conjunctival hyperemia, a 5-point grading scale (0 = none; 1 = mild; 2 = moderate; 3 = severe; and 4 = very severe) was used. 11,12 The cornea or tear fluid was stained with fluorescein test paper, and observations were made of SPK and tear film breakup time (BUT) under a slitlamp microscope. For all evaluations, the same investigator examined the same subject throughout the study period.…”

Intraocular Pressure and Conjunctival Hyperaemia with Bimatoprost Every 48 Hours Versus Every 24 Hours

“…16 As conjunctival hyperaemia with bimatoprost is highest during the first weeks and then diminishes by three months 17 , a reduced dose of bimatoprost may be better tolerated in the first weeks, whereas the standard regimen could be recommended later. We are aware that the method of subjectively grading ocular hyperaemia from direct observation 18 or colour photographs 8 is less sensitive and reliable than objective image analysis, 19 which requires appropriate software and instrumentation unavailable to us. Adherence and persistence is likely to be worse with prescriptions other than daily dosing.…”