Murphy P J, Lau J S C, Sim M M L, Woods R L
Cardiff University, School of Optometry and Vision Sciences, Cardiff, UK.
Eye (Lond). 2007 May;21(5):633-8. doi: 10.1038/sj.eye.6702295. Epub 2006 Mar 3.
To quantify the level of normal bulbar conjunctival hyperaemia using the Cornea and Contact Lens Research Unit (CCLRU) grading scale, and to investigate inter-observer agreement.
Bulbar conjunctival hyperaemia was assessed by two trained observers, using the CCLRU grading scale (zero to four units) interpolated into 0.1 increments, on the right eye of 121 healthy, non-contact lens-wearing subjects (male=58, female=63, median age=28 years, range 16-77). The eye was observed using a slit-lamp bio-microscope (x 10 magnification) under diffuse, white illumination. The subject's position of gaze was directed to allow grading of four quadrants: superior, nasal, inferior, and temporal conjunctiva. Bulbar redness was defined as the average of those four grades of conjunctival hyperaemia. A further twenty subjects were recruited to assess inter-observer agreement (male=8, female=12, median age=23 years).
The average bulbar redness was 1.93 (+/-0.32 SD) units. The nasal (2.3+/-0.4) and temporal (2.1+/-0.4) quadrants were significantly redder than the superior (1.6+/-0.4) and inferior (1.7+/-0.4) quadrants (P<0.0001). Males had redder eyes than females by 0.2 units. Inter-observer 95% limits of agreement for bulbar redness was 0.38 units.
The average bulbar redness of 1.9 units was higher than expected, reflecting the design of the grading scale. A bulbar redness of greater than 2.6 units may be considered abnormal, and a change in bulbar redness of > or =0.4 units may be significant.
使用角膜与隐形眼镜研究单位（CCLRU）分级量表对正常球结膜充血水平进行量化，并研究观察者间的一致性。
由两名经过培训的观察者，使用插值为0.1增量的CCLRU分级量表（0至4级），对121名健康、不佩戴隐形眼镜的受试者（男性58名，女性63名，年龄中位数28岁，范围16 - 77岁）的右眼进行球结膜充血评估。使用裂隙灯生物显微镜（放大倍数为10倍）在漫射白色照明下观察眼睛。受试者的注视位置被引导至可对四个象限进行分级：上方、鼻侧、下方和颞侧结膜。球结膜充血定义为这四个结膜充血等级的平均值。另外招募了20名受试者来评估观察者间的一致性（男性8名，女性12名，年龄中位数23岁）。
球结膜平均充血程度为1.93（±0.32标准差）级。鼻侧（2.3±0.4）和颞侧（2.1±0.4）象限比上方（1.6±0.4）和下方（1.7±0.4）象限明显更红（P<0.0001）。男性的眼睛比女性红0.2级。球结膜充血的观察者间95%一致性界限为0.38级。
1.9级的平均球结膜充血程度高于预期，这反映了分级量表的设计。球结膜充血程度大于2.6级可能被认为异常，球结膜充血变化≥0.4级可能具有显著性。
