SYMPTOMS

0

1

2

3

Itching

No desire to rub or stretch the eye

Occasional desire to rub or stretch the eye

Frequent need to rub or stretch the eye

Constant need to rub or stretch the eye

Tearing

Normal tear production

Positive sensation of fullness of the conjunctival sac without tears spilling over the lid margin

Intermittent, infrequent spilling of tears over the lid margin

Constant, or nearly constant, spilling of tears over the lid margin

Foreign body sensation

Absent

Mild, similar to fine dust sensation

Moderate, similar to sand sensation, with mild tearing and blinking

Severe, similar to big foreign body sensation, with constant tearing and blepharospasm

 

Photophobia

No difficulty experienced

Mild difficulty with light causing squinting

Moderate difficulty, necessitating dark glasses

Extreme photophobia causing the patient to stay indoors; cannot stand natural light even with dark glasses

Stinging

Absent

 

Mild

Moderate

Severe

Red eye

Absent

Mild, he/she cannot observe his red eye but is told he/she has it

Moderate, he/she can observe his red eye from 30 cms in a mirror

Severe, he/she can observe his red eye from more than 30 cms in a mirror

SIGNS

0

1

2

3

Conjunctival hyperemia 

Absent

Mild, in an area less than 25% of total conjunctival surface, including tarsal and bulbar

Moderate

Severe, with hyperemia in all conjunctival surface

Conjunctival discharge

Absent

Small amount of translucent or whitish discharge in the lower cul-de-sac

Moderate amount of like yellow or green-yellowish discharge in the lower cul-de-sac and in the marginal tear strip

Severe, with blood traces in the lower cul-de-sac and in the marginal tear strip

 

Tarsal conjunctival papillary hypertrophy

No evidence of papillary formation

Mild papillary hyperemia

Moderate papillary hypertrophy with edema of the palpebral conjunctiva and hazy view of the deep tarsal vessel

Severe papillary hypertrophy obscuring the visualization of the deep tarsal vessels

Chemosis

Absent

Mild, in an area less than 25% of total conjunctival surface, including tarsal and bulbar

Moderate

Severe, with volume augmentation in all conjunctival surface

Table 2: Grading Scale for Ocular Signs and Symptoms in VKC study.