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

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Contact Lenses Grading Scales

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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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