April 2010
Volume 51, Issue 13
ARVO Annual Meeting Abstract  |   April 2010
Development of a Redness Scale for Morning Eye Congestion
Author Affiliations & Notes
  • S. Breton
    R & D, ORA, Andover, Massachusetts
  • K. J. Lane
    Clinical R & D,
    Ora, Inc., Andover, Massachusetts
  • P. J. Gomes
    Ora, Inc., Andover, Massachusetts
  • A. Shapiro
    Anti-Inflamm, Anti-Infect, Devices,
    Ora, Inc., Andover, Massachusetts
  • G. W. Ousler, III
    Dry Eye Dpmt,
    Ora, Inc., Andover, Massachusetts
  • D. Welch
    Ora, Inc., Andover, Massachusetts
  • M. B. Abelson
    Immunol-Schepens Eye Res Inst,
    Ora, Inc., Andover, Massachusetts
  • Footnotes
    Commercial Relationships  S. Breton, Ora, E; K.J. Lane, Ora, Inc., E; P.J. Gomes, Ora, Inc., E; A. Shapiro, Ora, Inc., E; G.W. Ousler, III, Ora, Inc., E; D. Welch, Ora, Inc., E; M.B. Abelson, Ora, Inc., E; Schepens Eye Research Institute, E; Harvard Medical School, E.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 2389. doi:
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      S. Breton, K. J. Lane, P. J. Gomes, A. Shapiro, G. W. Ousler, III, D. Welch, M. B. Abelson; Development of a Redness Scale for Morning Eye Congestion. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2389.

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      © ARVO (1962-2015); The Authors (2016-present)

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Many ophthalmic conditions share redness as a clinical sign; however, the specific pattern of redness under these different pathological conditions is greatly varied. The conjunctival, scleral, episcleral, and ciliary vessel beds are known to respond to different disease states through variations in color, location, pattern, and amount of redness.Prior to developing a redness scale for morning congestion, individual specific redness scales were used for dry eye, allergic conjunctivitis, bacterial conjunctivitis, and glaucoma. Studying many cases of redness secondary to morning eye congestion further supported that this type of redness could not be represented by one of the existing scales. Redness resulting from morning eye congestion presents itself as fine linear conjunctival and ciliary vessel dilation. In an effort to better represent this specific pattern of ocular redness, we sought to develop a specific standardized redness scale.


Over 100 subjects were photographed bilaterally upon awakening using a Nikon D40x, a digital SLR, with a specialized Sigma EX macro lens. These subjects presented with varying levels of redness secondary to morning eye congestion. Digital photographs were reviewed by a panel of three clinicians and were arranged from least severe to most severe and representative photographs were selected to generate a 0-3 scale. Steps were taken to assure reproducibility and equal magnitude between points on the scale.


The following scale was generated using the above methodology.


It is important that individual scales are developed because a subject’s disease should be precisely documented in all cases. Accuracy of assessment is most important and a scale should represent a full range of redness for a specific disease. Prior scales have aided in developing therapies for leaders in the ophthalmic pharmaceutical industry, confirming the value of disease-specific redness scales to maximize accuracy of assessments of disease severity.  

Keywords: anterior segment • conjunctiva • clinical (human) or epidemiologic studies: systems/equipment/techniques 

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