Grading in ophthalmology, Ptosis, Entropion, Ectropion,Cataract, Hyphema, RAPD and AC cells - Eye Health Nepal, Eye Care Information

Grading in ophthalmology, Ptosis, Entropion, Ectropion,Cataract, Hyphema, RAPD and AC cells

Grading in Ophthalmologuy

How to grade everything in ophthalmology?

Grading in ophthalmology is an ever-evolving concept. Some grading systems which is used commonly are as follows. 

Grading of Ptosis:

Ptosis is a drooping of the upper eyelid.

Marginal Reflex Distance MRD (Distance between Upper lid margin and corneal light reflex)
ptosis grading



Grading of Entropion:

Lid margin is inturned
Depending on the degree of in turning, dividing into three grades.


  1. Grade 1: only the posterior lid border is inrolled. 
  2. Grade 2: inturning of the intermarginal strip. 
  3. Grade 3: whole lid margin including anterior border inturned

Lower lid entropion, Trichiasis

Grading of Ectropion

It is an outward rolling of the lid margin.


  1. Grade 1: The only punctum everted
  2. Grade 2: Lid margin is everted and palpebral conjunctiva is visible.
  3. Grade 3: Fornix is visible


ectropion

Grading of Hyphema:

Hyphemas can be graded from grade  I-IV
  • Grade 0: No visible layering, but red blood cells within the anterior chamber (microhyphema)
  • Grade I: Layered blood occupying less than 1/3 of the anterior chamber 
  • Grade II: Blood filling 1/3 to 1/2 of the anterior chamber 
  • Grade III: Layered blood filling ½ to less than total of the anterior chamber 
  • Grade IV: Total clotted blood, often referred to as blackball or 8-ball hyphema 
hyphema grading

Anterior Chamber (AC) Cells Grading: 

ac cells grading, flare grading aao

AC Flares:

0  Complete absence
1+ Faint flare (barely detectable)
2+ Moderate flare (iris and lens still clear)
3+ Marked flare(iris and lens hazy)
4+ Intense flare(coagulate aqueous, no circulation, fibrin visible)

Grading of AC cells and flare

Van Herick’s AC Depth Grading:  

The peripheral anterior chamber depth (PACD) is compared to the adjacent corneal thickness (CT) and the presumed angle width is graded as follows:

Grade 4 (Wide open angle): PACD = 3 / 4 to 1 CT
Grade 3 (Mild narrow angle): PACD = ¼ to ½ CT
Grade 2 (Moderate narrow angle): PACD = ¼ CT
Grade 1 ( Extremely narrow angle): PACD < ¼ CT  
Grade 0 (closed angle): PACD = Nil

Van Herick’s AC Depth Grading:

Nuclear Sclerosis Grading: 

NS Grading
cataract grading

Posterior Sub Capsular Cataract (PSCC) Grading : 

pscc grading

Diabetic Retinopathy Grading: 

diabetic retinopathy grading

Hypertensive Retinopathy Gradings:

HTN retinopathy grading 

RAPD Grading 

1+ Weak initial constriction followed by greater redilation
2+ Initial pupillary stall followed by greater redilation
3+ Immediate pupillary dilation
4+ No reaction to light

Papilledema Grading:

papilledema grading

Vitreous Haze Grading: 

VH Grading

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