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GRADING SCALES

*
1. TRACE

2. MILD

3. MODERATE

4. SEVERE

BULBAR REDNESS

LIMBAL REDNESS

PALPEBRAL REDNESS

PALPEBRAL ROUGHNESS

CORNEAL STAINING - TYPE

MICROPUNCTATE

MACROPUNCTATE

COALESCENT

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Identified by side showing brightness. 4.2015 *For guidance only unreversed . • In general. Signs Signs • Redness • Enlarged papillae • Excess mucus • No stromal inflammation • Immediate spread of fluorescein into stroma Symptoms Symptoms • Can be painful • Photophobia • Lacrimation • Itchiness • Mucus strands • Lens mislocation • Intolerance to lenses INFILTRATES CLPU CONTACT LENS PERIPHERAL ULCER Accumulation of inflammatory cells in corneal sub-epithelial stroma. VERY SLIGHT VASCULARISATION 2. typically central or paracentral. Insets: with fluorescein. • A change of one grade or more at follow up visits is considered clinically significant. usually confined to 2-3mm from limbus • Localised redness • Infiltrates • Post healing scar Symptoms • Asymptomatic or scratchy. Signs Signs • Whitish opacity (focal) or grey haze (diffuse) • Localized redness • Unilateral. Round. scar. Signs Signs • Intense redness • “White patch” (raised edges) • Infiltrates • Epithelial and stromal loss • Anterior chamber flare • Conjunctival and lid edema • Unilateral • Intense redness • Infiltrates • No epithelial break Symptoms Symptoms • Wakes with irritation or pain • Photophobia • Lacrimation • Pain. typically in the corneal periphery which results in a scar. • The cornea is divided into five areas. reversed Microcysts Vacuoles Record number observed Record number observed © Copyright Brien Holden Vision Institute 1993 . tearing and photophobia possible Symptoms • Varies from foreign body sensation to pain • Lacrimation and photophobia may occur MICROBIAL KERATITIS CLARE CONTACT LENS ACUTE RED EYE An acute corneal inflammatory episode associated with sleeping in soft contact lenses. MODERATE STROMAL STRIAE and FOLDS MICROCYSTS and VACUOLES One striae = 5% edema One fold = 8% edema (each additional striae or fold indicates 1% more edema) Vessel extension beyond translucent limbal zone is recorded (mm). CORNEAL STAINING GRADES • Staining assessed immediately after single instillation of fluorescein using cobalt blue light and wratten 12 (yellow) filter over the slit lamp objective. foreign body sensation • Redness. photophobia • Redness. full thickness epithelial loss with inflamed base. • Areas 1. SLIGHT 3. Full thickness epithelial loss over a discrete area. • Patient management is based on how much the normal ocular appearance has changed.GRADING SCALES* PALPEBRAL CONJUNCTIVAL GRADES APPLICATION OF GRADING SCALES • The palpebral conjunctiva is divided into five areas to grade redness and roughness. 2 and 3 are most relevant in contact lens wear. Full thickness epithelial loss with stromal necrosis and inflammation. The type of staining is graded in each area. mucoid discharge •  VA (if over pupil) POLYMEGETHISM 1. ADVERSE EFFECTS WITH CONTACT LENSES CLPC CONTACT LENS PAPILLARY CONJUNCTIVITIS EROSION Inflammation of the upper palpebral conjunctiva. Inset: high magnification view. “white spot”. a rating of grade 2 or less is considered within normal limits (except staining). SEVERE Located in epithelium.