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P.J. Murphy, J.S. C. Lau, M.M. L. Sim, R.L. Woods; How red is a white eye? . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1562.
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Purpose: To quantify bulbar conjunctival hyperaemia (redness) of otherwise healthy eyes using the CCLRU grading scale, and to investigate inter–observer agreement. Methods: Bulbar redness of 121 healthy, non–contact lens–wearing subjects (m=56, f=63, median age=28 years, range 16–77) was assessed by two trained observers using the CCLRU grading scale, interpolated to 0.1 unit increments. The right eye only of each subject was examined using a slit–lamp biomicroscope (x10 mag.) under diffuse, white illumination. The subject’s position of gaze was directed to allow grading of four quadrants: superior, nasal, inferior and temporal conjunctiva. In addition, overall bulbar redness was graded. A further 20 subjects were recruited to assess inter–observer agreement (m=8, f=12, median age=23). The two observers graded each subject independently (i.e. masked from each other’s observations). Results: Average overall bulbar redness was 1.9 (±0.5 s.d.) units. The nasal (2.3±0.4) and temporal (2.1±0.4) quadrants were redder than the superior (1.7±0.4) and inferior (1.6±0.4) quadrants. A significant difference in bulbar redness was found between all quadrants (t–test, p<0.01), except superior/inferior (t=1.94, p=0.054). Bulbar redness increased with age by 0.29 units between the ages of 20 and 70 years (r=0.234, p=0.01). Males, at all ages, tended to have redder eyes by approximately 0.18 units. Inter–observer agreement: No significant difference was found between observers, overall or for each quadrant (t<1.54, p>0.14), except the temporal quadrant (t=2.54, p=0.02). The 95% confidence limits were 0.26 units for overall bulbar redness grade, with a maximum of 0.41 (inferior) and minimum of 0.24 (nasal) units. Conclusions: (1) When no previous assessment of bulbar redness is available, an overall redness grade of 2.7 units or more may be considered abnormal. (2) The Grade 1 image for the CCLRU scale is unusually white, and does not reflect the ‘normal’ grade. (3) Higher redness in the temporal and nasal quadrants probably reflects exposure to environmental conditions. (4) Bulbar redness varied with age and sex. (5) A change in overall redness grade of 0.3 units or more may be significant.
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