Clinical grading of the upper palpebral conjunctiva of non-contact lens wearers

Optom Vis Sci. 2001 Jan;78(1):13-8. doi: 10.1097/00006324-200101010-00009.


Purpose: To categorize the appearance of the normal upper palpebral conjunctiva using a grading scale and to investigate interobserver agreement with a grading scale modified to include decimal increments.

Methods: Upper palpebral conjunctival appearance of 96 non-contact lens wearing subjects aged 18 to 75 years was assessed using a photographic grading scale that has a generic (zero to four) scale to score redness and roughness of the palpebral conjunctiva.

Results: Median redness and roughness was about 1.25 units. About 5% of subjects had redness or roughness >2.0 units. Interobserver agreement improved during the study. By the end of the study, the standard deviation of the discrepancy scores was 0.12 to 0.19 units.

Conclusions: Upper palpebral conjunctival redness or roughness >2.0 units are unusual. The grading scale can be used successfully with decimal rather than integer scale increments. For experienced clinicians, a change in grade of > or =0.5 units may be significant.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Conjunctiva / pathology*
  • Conjunctival Diseases / classification*
  • Conjunctival Diseases / etiology
  • Conjunctival Diseases / pathology
  • Cross-Sectional Studies
  • Eyeglasses / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Prevalence
  • Scotland / epidemiology
  • Severity of Illness Index*