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

Grading of Entropion:
Lid margin is inturnedDepending on the degree of in turning, dividing into three grades.
- Grade 1: only the posterior lid border is inrolled.
- Grade 2: inturning of the intermarginal strip.
- Grade 3: whole lid margin including anterior border inturned

Grading of Ectropion
It is an outward rolling of the lid margin.- Grade 1: The only punctum everted
- Grade 2: Lid margin is everted and palpebral conjunctiva is visible.
- Grade 3: Fornix is visible
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
Anterior Chamber (AC) Cells Grading:
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)
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
Nuclear Sclerosis Grading:
Posterior Sub Capsular Cataract (PSCC) Grading :
Diabetic Retinopathy Grading:
Hypertensive Retinopathy Gradings:
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
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