Grading of tarsal conjunctiva of young adults in Malaysia

Abstract

Background:The monitoring and assessment of the upper tarsal conjunctiva can be enhanced by the use of a grading scale. The aim of this study was to categorise the appearance of normal tarsal conjunctiva among young adults in Malaysia using the Institute for Eye Research grading scale and to investigate inter-and intra-observer agreement. Methods: The appearance of the upper tarsal conjunctiva of 416 non-contact lens wearing subjects aged between 19 to 24 years was assessed by two separate observers for roughness and redness in three separate zones using the Institute for Eye Research grading scale. The average grade for each zone and overall grade for roughness and redness were calculated. Inter-and intra-observer agreements were analysed. Results: Subjects were categorised for ethnicity and the roughness and redness were calculated. No significant differences were found between Malay and Chinese eyes (p > 0.05). The average grades for the upper tarsal conjunctiva redness and roughness were 0.90 Ϯ 0.25 and 0.86 Ϯ 0.43, respectively. Significantly higher roughness scores were found in zone 1 compared to the other two zones (p = 0.03). Significant association was also found between tarsal conjunctiva redness and roughness (Spearman r = 0.45, p < 0.001). Correlation between redness and roughness with age (p = 0.48, p = 0.65) and gender (p = 0.30, p = 0.79) were not significant. Only 2.2 per cent of subjects had scores higher than 2.0 for roughness or redness. Inter-and intra-observer analysis showed good agreement between two observers during the study. Conclusion:The roughness and redness of normal tarsal conjunctiva among young adults in Malaysia were found to be less than two units. Results of this study might be beneficial in clinical trials using contact lenses where changes in the tarsal conjunctiva are commonly used as an outcome measure.

The Ocular Redness Index: A Novel Automated Method for Measuring Ocular Injection

“…These scales consist of a series of 'standardized' images representing different degrees of ocular injection, which are used for comparison to a patient's conjunctiva. 6,7 Since OR evaluation using image-based comparative scales relies on an observer's judgment, and involves a high degree of subjectivity, this technique is also prone to imprecision. Other methods to assess OR include objective methods that evaluate the chromatic characteristics of the ocular surface or computer-based systems capable of analyzing OR in photographs.…”

Impression Cytology of Tarsal Conjunctiva in Long-Standing Ocular Prosthesis Wearers: Case Reports

“…There were slight redness and swelling of the upper lid on the day of her examination but with no pain or discharge. Using slit-lamp biomicroscopy, the appearance (roughness and redness) of the upper tarsal conjunctiva was graded following Institute of Eye Research (IER) grading scale of contact lens complications [10]. In this case, both redness and roughness were graded as 4.0 which indicates the appearance of GPC on her upper tarsus.…”