Ординатура / Офтальмология / Английские материалы / Quick Reference Dictionary of Eyecare Terminology 4th edition_Ledford, Hoffman_2005
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274 Appendix 8
With that said, we would like to offer our own opinion about how to grade your findings. Some prefer a numbered grading system. If you use this, then 0+ means that a finding is absent. 1+ would indicate that a finding is just barely perceptible. 4+ would refer to a full-blown case. Using this schematic, 2+ and 3+ would fall somewhere in between. Interjecting half steps, such as 2.5+, sometimes complicates this system. We will leave it up to you as to whether this practice is truly necessary or not.
Instead of numbers, specific terms can be used, including “none, absent, bare trace, trace, slight, moderate, marked, severe,” and other such words. This is even more subjective than the numbering system. If everyone uses a scale of 0 to 4, then we have a better chance of understanding what 2+ means. Who is to say what the difference really is between “bare trace” and “trace”? (Alas, perhaps it is that nebulous 0.5 half-step!) The dilemma of subjective grading is not likely to be resolved.
The Subjective Grading System |
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GRADING INJECTION |
|
|
Features |
Grade |
|
No injection present |
0 |
|
Slight limbal (mild segmented), bulbar |
1 |
|
(mild regional), and/or palpebral injection |
|
|
Mild limbal (mild circumcorneal), bulbar |
2 |
|
(mild diffuse), and/or palpebral injection |
|
|
Significant limbal (marked segmented), |
3 |
|
bulbar (marked regional or diffuse), or |
|
|
palpebral injection |
|
|
Severe limbal (marked circumcorneal), |
4 |
|
bulbar (diffuse episcleral or scleral), or |
|
|
palpebral injection |
|
|
Adapted from FDA document Premarket Notification Guidance Document for Daily Wear Contact Lenses. Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
GRADING CORNEAL HAZE |
|
Features |
Grade |
Clear |
0 |
Between clear and trace; barely perceptible |
0.5+ |
Trace; easily seen with slit lamp |
1+ |
Mild haze |
2+ |
276 |
Appendix 8 |
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|
Features |
Grade |
Moderate haze, very pronounced, iris |
3+ |
|
details still visible, anterior chamber (AC) |
|
|
reaction not visible |
|
|
Marked haze, scarring, iris details obscured |
4+ |
|
Adapted from Stein HA, Cheskes AT, Stein RM. The Excimer: Fundamentals & Clinical Use. Thorofare, NJ: SLACK Incorporated; 1995.
GRADING CORNEAL VASCULARIZATION
Features |
Grade |
No vascular changes |
0 |
Congestion and dilation of the limbal |
1 |
vessels; single vessel extension < 1.5 mm |
|
Extension of multiple vessels < 1.5 mm |
2 |
Extension of multiple limbal vessels 1.5 |
3 |
to 2.5 mm |
|
Segmented or circumscribed extension of |
4 |
limbal vessels > 2.5 mm or to within 3.0 |
|
mm of corneal apex |
|
Adapted from FDA document Premarket Notification Guidance Document for Daily Wear Contact Lenses. Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
The Subjective Grading System |
277 |
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GRADING CORNEAL STAINING |
|
|
Features |
Grade |
|
No staining |
0 |
|
Minimal superficial staining or stippling |
1 |
|
Regional or diffuse punctate staining |
2 |
|
Significant dense coalesced staining, corneal |
3 |
|
abrasion, or foreign body tracks |
|
|
Severe abrasions > 2 mm diameter, ulcer- |
4 |
|
ations, epithelial loss, or full-thickness |
|
|
abrasion |
|
|
Adapted from FDA document Premarket Notification Guidance Document for Daily Wear Contact Lenses. Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
GRADING ANGLES |
|
Features |
Grade |
Closed angle |
0 |
Angle extremely narrow, probable closure |
1+ |
Angle moderately narrow, possible closure |
2+ |
Angle moderately open, closure not possible |
3+ |
Angle wide open, closure not possible |
4+ |
Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
278 Appendix 8
GRADING CELL (1 MM CONICAL BEAM)
Cell # |
Grade |
1 to 10 |
Trace |
10 to 20 |
1+ |
20 to 30 |
2+ |
30 to 40 |
3+ |
40 up to hypopyon |
4+ |
Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
GRADING CORTICAL CATARACTS
Features |
Grade |
|
Gray lines, dots, and flakes aligned |
1+ |
(early or |
along the cortical fibers in periphery; |
incipient) |
|
visible in oblique direct illumination |
|
|
Opaque spokes, anterior chamber may |
2+ |
(immature |
be shallower than normal for patient |
or intumescent) |
|
Cortex opaque up to capsule, anterior |
3+ |
(mature) |
chamber may be normal depth |
|
|
Lens is smaller, wrinkly capsule, |
4+ |
(hyperma- |
nucleus may float in liquified cortex |
ture) |
|
Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
The Subjective Grading System |
279 |
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GRADING NUCLEAR SCLEROTIC CATARACTS |
||
Lens Color |
Grade |
|
Gray-blue (normal) |
0 |
|
Yellow overtone |
1+ |
|
Light amber |
2+ |
|
Reddish brown |
3+ |
|
Brown or black, opaque; no fundus reflection |
4+ |
|
Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
GRADING POSTERIOR SUBCAPSULAR CATARACTS
Features |
|
Grade |
Optical irregularity on posterior |
1+ |
|
capsule; visible only on |
|
|
retroillumination |
|
|
Small, white fleck |
2+ |
(early) |
Enlarged plaque; round or irregular |
3+ |
(moderate) |
borders |
|
|
Opaque plaque |
4+ |
(advanced) |
Reprinted with permission from Ledford JK, Sanders VN. The Slit Lamp Primer. Thorofare, NJ: SLACK Incorporated; 1998.
A P P E N D I X 9
Slit Lamp Findings for Systemic Diseases and Conditions
Some of these findings are admittedly rare.
Conjunctivitis can include conjunctival redness, conjunctival edema, excessive tearing, and matter/discharge.
See also notes on medications used to treat ocular conditions (Appendix 13).
For other complications of systemic disorders, see Appendix 10.
abuse (physical): Lid bruises and swelling, lid burns, subconjunctival hemorrhage (may be numerous and tiny), corneal abrasion, hyphema, traumatic cataract, lens subluxation.
acne: See rosacea.
acquired immunodeficiency syndrome (AIDS):
Exophthalmos; conjunctivitis (recurrent infections); dry eye; Kaposi’s sarcoma (reddish-blue vascular nodules) of lids, palpebral conjunctiva, or orbit.
albinism: Nystagmus, white brows and lashes, reddish iris.
alcoholism: Ptosis, nystagmus, iris paralysis.
allergies: Conjunctivitis, congestion of conjunctival blood vessels, dry eye (secondary to medication), iritis (seasonal).
anemia: Subconjunctival hemorrhage. ankylosing spondylitis: Iritis. arteriosclerosis: Arcus senilis.
asthma: Conjunctivitis, cataract (secondary to corticosteroid treatment).
Bell’s palsy: Incomplete or absent lid closure, exposure keratitis.
282 Appendix 9
breast cancer: Metastatic lesion to angle, metastatic lesion to iris, other metastatic lesions (visible mass, redness), symptoms of metastatic lesions (exophthalmos, hyphema).
cancer: See breast cancer, colon cancer, leukemia, lung cancer, and melanoma.
Candida albicans (yeast): Swelling of lacrimal gland, lid “thrush,” conjunctivitis, stringy mucus, keratitis, pseudomembranes.
carotid artery disease: Dilation of conjunctival blood vessels, iritis.
chickenpox: Vesicles on lid, conjunctivitis, abnormal pupil, superficial punctate keratitis, iritis.
Chlamydia: Lid swelling, conjunctival injection, conjunctivitis, conjunctival pseudomembranes, keratitis, corneal vascularization.
colon cancer: Metastatic lesions (visible mass, redness), symptoms of metastatic lesions (exophthalmos, hyphema).
craniofacial syndromes: Exophthalmos, nystagmus, exposure keratitis, coloboma.
diabetes: Xanthelasma, corneal wrinkles, rubeosis of iris, loss of iris pigment, cataract, asteroid hyalosis.
Down syndrome: Nystagmus, epicanthal folds, keratoconus, iris spots, Brushfield’s spots (gray or white spots around the edge of the iris), cataract.
eczema: Lid crusting, scaling, and oozing (blepharitis); conjunctivitis; conjunctival thickening; congestion of conjunctival blood vessels; dry eyes; keratoconus; cataract.
emphysema: Cataract (secondary to corticosteroid treatment).
endocarditis: Nystagmus, tiny red dots on conjunctiva, anisocoria, iritis.
facial deformity syndromes: Microphthalmos, downsloping lid slant, nystagmus, lower lid coloboma, dermoid cysts of the globe, cataract.
Slit Lamp Findings for Systemic Diseases |
283 |
German measles (congenital defects following maternal infection): Microphthalmos, nystagmus, corneal edema, corneal clouding, iris atrophy, aniridia, cataract.
German measles (acute postnatal cases): Follicular conjunctivitis.
gonorrhea (neonatorum): Edema of orbit, lid edema, congestion of conjunctival blood vessels, conjunctival chemosis, purulent conjunctivitis, conjunctival pseudomembranes, keratitis, corneal perforation, iritis.
gout: Episcleritis, scleritis, corneal crystals, iritis.
hay fever: Conjunctivitis, congestion of conjunctival blood vessels, dry eye (secondary to medication), iritis (seasonal).
Herpes simplex (congenital defects following maternal infection): Cataract.
Herpes simplex (acute postnatal cases): Lid lesions, follicular conjunctivitis, limbal dendrites, corneal dendrites, corneal edema.
Herpes zoster: See shingles. histoplasmosis: Conjunctivitis. hypertension: Arcus senilis.
hypervitaminosis A, B, and D: Exophthalmos, calcium deposits in conjunctiva (D), band keratopathy (D), cataract (D).
influenza: Keratitis.
leprosy: Lash loss (brows and lids), paralysis of lid, thickened corneal nerves, corneal pannus, corneal scarring, corneal perforation, keratitis, iritis, iris nodules, cataract.
leukemia: Exophthalmos, metastatic lesions (visible mass, redness), symptoms of metastatic lesions (exophthalmos, hyphema).