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Development and Validation of a Standardized Palpebral Conjunctival Redness Scale.

Jared W Lim1, Calvin W Wong2, Nathan A Seto3

  • 1McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA.

Cureus
|February 23, 2026
PubMed
Summary

A new palpebral conjunctival redness (PCR) scale was developed and validated for assessing ocular inflammation. This scale offers improved diagnostic sensitivity for conditions affecting the inner eyelid compared to existing bulbar conjunctival redness (BCR) measures.

Keywords:
bulbar conjunctival rednessconjunctival assessmentgrading scaleinter-rater reliabilitypalpebral conjunctival redness

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Area of Science:

  • Ophthalmology
  • Immunology
  • Medical Imaging

Background:

  • Ocular inflammation assessment traditionally relies on bulbar conjunctival redness (BCR) scales.
  • The palpebral conjunctiva has distinct vascular and immune properties requiring a specialized assessment tool.
  • Existing scales may not accurately capture inflammation localized to the palpebral conjunctiva.

Purpose of the Study:

  • To develop and validate a standardized palpebral conjunctival redness (PCR) scale.
  • To address the unique anatomical and immunological characteristics of the palpebral conjunctiva.
  • To enhance clinical assessment of ocular inflammation in specific regions.

Main Methods:

  • A 10-point PCR grading scale was created using digital image manipulation (Adobe Photoshop).
  • The scale was validated by trained ophthalmic professionals assessing 24 eyes.
  • Statistical analyses included Cronbach's alpha, ICC, paired t-tests, and Pearson's correlation.

Main Results:

  • The PCR scale demonstrated excellent inter-rater reliability (ICC=0.773) and strong internal consistency (Cronbach's alpha=0.880).
  • Mean PCR scores were significantly higher than BCR scores (p<0.0001).
  • A moderate correlation (r=0.45) was observed between PCR and BCR scales.

Conclusions:

  • A reliable and clinically applicable PCR grading scale was successfully established.
  • The PCR scale complements BCR assessments, highlighting the need for region-specific tools.
  • This scale enhances diagnostic sensitivity for palpebral conjunctival conditions.