Clinical Grading of the Upper Palpebral Conjunctiva of Non‐Contact Lens Wearers

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 ≥0.5 units may be significant.