Novel Grading Scale for Conjunctival Inflammation in Cicatrizing Conjunctivitis Associated with Pemphigoid

To develop a novel grading scale for assessing conjunctival inflammation in cicatrizing conjunctivitis associated with Pemphigoid.

We performed a retrospective analysis of digital slit-lamp images for patients with cicatricial pemphigoid in which best-quality conjunctival images for each eyelid at each photographic session was selected and anonymized. These images were subsequently prospectively assessed for inflammation severity on a scale of 0-4+ by a fellowship-trained ophthalmologist specializing in pemphigoid. The most representative image grade of inflammation was then compiled to create a visual composite, accompanied by corresponding verbal descriptions for each level of inflammation. The primary outcome measure was the development of a novel 4-point grading scale demonstrating progressive degrees of conjunctival inflammation in patients with cicatrizing conjunctivitis associated with pemphigoid.

A total of 6,969 conjunctival images from 113 patients with cicatrizing conjunctivitis secondary to pemphigoid were reviewed and narrowed to 452 images, each representing the best single clarity image from each eyelid per photo session. The images were then sorted into five groups by degree of inflammation (0-4+). The most representative photographs of the upper and lower eyelids in each group were then selected to create a visual composite with an associated verbal descriptor for each level of inflammation.

A novel 4-point grading scale was developed incorporating both verbal descriptors and visual components to quantify conjunctival inflammation in patients with cicatrizing conjunctivitis associated with Pemphigoid.