PURPOSE: To describe the Oxford Scheme for grading ocular surface staining in dry eye and to discuss optimization of stain detection using various dyes and filters. Also, to propose a sequence of testing for dry eye diagnosis. METHODS: The grading of corneal and conjunctival staining is described, using the Oxford Scheme, including biomicroscopy, optical filters, illumination conditions, and the characteristics of and instillation techniques used for, selected clinical dyes. RESULTS: A series of panels, labeled A-E, in order of increasing severity, reproducing the staining patterns encountered in dry eye, are used as a guide to grade the degree of staining seen in the patient. The amount of staining seen in each panel, represented by punctate dots, increases by 0.5 of the log of the number of dots between panels B to E. The use of the vital dyes fluorescein, lissamine green, and rose Bengal is described; fluorescein and lissamine green, used in conjunction with appropriate absorption filters, are recommended for use in clinical trials. The placement of staining in relation to the sequence of other diagnostic tests is discussed. CONCLUSIONS: The monitoring and assessment of corneal and conjunctival staining can be greatly enhanced by the use of a grading scale, controlled instillation of dyes, and standard evaluation techniques. This is of particular benefit in clinical trials, where ocular surface staining is commonly employed as an outcome measure
PURPOSE: To describe the Oxford Scheme for grading ocular surface staining in dry eye and to discuss optimization of stain detection using various dyes and filters. Also, to propose a sequence of testing for dry eye diagnosis. METHODS: The grading of corneal and conjunctival staining is described, using the Oxford Scheme, including biomicroscopy, optical filters, illumination conditions, and the characteristics of and instillation techniques used for, selected clinical dyes. RESULTS: A series of panels, labeled A-E, in order of increasing severity, reproducing the staining patterns encountered in dry eye, are used as a guide to grade the degree of staining seen in the patient. The amount of staining seen in each panel, represented by punctate dots, increases by 0.5 of the log of the number of dots between panels B to E. The use of the vital dyes fluorescein, lissamine green, and rose Bengal is described; fluorescein and lissamine green, used in conjunction with appropriate absorption filters, are recommended for use in clinical trials. The placement of staining in relation to the sequence of other diagnostic tests is discussed. CONCLUSIONS: The monitoring and assessment of corneal and conjunctival staining can be greatly enhanced by the use of a grading scale, controlled instillation of dyes, and standard evaluation techniques. This is of particular benefit in clinical trials, where ocular surface staining is commonly employed as an outcome measure
Authors: Loretta Szczotka-Flynn; Jonathan H Lass; Ajay Sethi; Sara Debanne; Beth Ann Benetz; Matthew Albright; Beth Gillespie; Jana Kuo; Michael R Jacobs; Alfred Rimm Journal: Invest Ophthalmol Vis Sci Date: 2010-06-10 Impact factor: 4.799
Authors: Brian P Brooks; Amy H Thompson; Janine A Clayton; Chi-Chao Chan; Deborah Tamura; Wadih M Zein; Delphine Blain; Casey Hadsall; John Rowan; Kristen E Bowles; Sikandar G Khan; Takahiro Ueda; Jennifer Boyle; Kyu-Seon Oh; John J DiGiovanna; Kenneth H Kraemer Journal: Ophthalmology Date: 2011-09-28 Impact factor: 12.079
Authors: Anat Galor; William Feuer; David J Lee; Hermes Florez; Vincent D Venincasa; Victor L Perez Journal: Invest Ophthalmol Vis Sci Date: 2013-02-19 Impact factor: 4.799