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

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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