Normal grade Comment Bulbar redness Aetiology Dilation of bulbar vessels, e.g. due to mechanical stimulation, allergy/hypersensitivity etc Up to grade 2 Useful to evaluate using the same magnification each time Normal grade Comment Tarsal redness Aetiology Dilation of tarsal vessels, e.g. due to preservatives in lens care products, ocular dryness, mechanical irritation etc Up to grade 2 Roughness of the tarsal conjunctiva increases in higher grades GRADE 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4 Normal grade Comment Limbal redness Aetiology Dilation of bulbar vessels, e.g. due to hypoxia Up to grade 2 Often seen in combination with bulbar redness Aetiology Normal grade Comment Corneal neovascularisation Primarily due to corneal hypoxia Grade 0 Classification based on the extent of blood vessel ingrowth 0 mm < 1 mm 1 - 1,5 mm 1,5 - 2 mm > 2 mm Corneal staining: Dessication Aetiology Normal grade Comment Superficial cells of the corneal epithelium become damaged Grade 0. Grade 1 may be a normal consequence of an incomplete blink Stain with fluorescein, view with blue light and a yellow filter in Puurs, CPAK production site Contact Lenses Grading Scales 14082-Alcon-GRADING-SCALES-2PP.indd 1 11/07/2019 04:29
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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
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
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