Interest in the temperature of the eye spans almost 130 years. It has been an area of research largely driven by prevailing technology. Current instrumentation offers the potential to measure ocular surface temperature with more accuracy, resolution, and speed than previously possible. The use of dynamic ocular thermography offers great opportunities for monitoring the temperature of the anterior eye.

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Contact lens wearers with dryness symptoms exhibit significantly more LWE and LIPCOF, but not increased corneal staining, bulbar hyperaemia or decreased PLBUT. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. LIPCOF Sum severity scores appear to be most predictive for symptoms.

28 29Purpose: This paper reports on the development of a new tear ferning (TF) subjective 30 grading scale, and compares it with the Rolando scale. 31Method: TF patterns obtained from tear film samples collected from normal and dry eye 32 subjects in previous studies were collated into a large image library. From this library, 60 33 images were selected, to represent the full range of possible TF patterns, and a further sub-34 set of 15 images was chosen for analysis. Twenty-five optometrists were asked to rank the 35 images in increasing order between extreme anchors on a scale of TF patterns. Interim 36 statistical analysis of this ranking found 7 homogeneous sub-sets, where the image rankings 37 overlapped for a group of images. A representative image (typically the mean) from each 38 group was then adopted as the grade standard. Using this new 7-point grading scale, 25 39 optometrists were asked to grade the entire 60 image library at two sessions: once using the 40 4-point Rolando scale and once using the new 7-point scale, applying 0.25 grade unit 41 interpolation. 42Results: Statistical analysis found that, for the larger image set, the Rolando scale produced 43 3 homogeneous sub-sets, and the 7-point scale produced 5 homogeneous sub-sets. With this 44 refinement, a new 5-point TF scale (Grades 0−4) was obtained. 45 Conclusions:The Rolando grading scale lacks discrimination between its Type I and II 46 grades, reducing its reliability. The new 5-point grading scale is able to differentiate between 47 TF patterns, and may provide additional support for the use of TF for both researcher and 48 clinician. 49 50