{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:14:45Z","timestamp":1788912885288,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Conjunctival inflammation assessment is fundamental for diagnosing and monitoring various ocular surface diseases. This review summarizes grading scales available for conjunctival inflammation, discussing both subjective and objective methodologies. Widely used clinical grading systems include slit-lamp findings classification scale, Mandell scale for conjunctival injection, McMonnies and Champman-Davies scale, CCLRU (Cornea and Contact Lens Research Unit) scale, Efron scale, and VBR (validated bulbar redness) scale. They provide standardized frameworks for assessing conjunctival hyperemia and inflammation severity. However, these subjective methods are limited by inter-observer variability and lack of precision in detecting subtle changes. Recent technological advances have introduced objective digital imaging systems and automated algorithms that may offer improved reproducibility and sensitivity. Novel approaches include the integration of artificial intelligence for automated assessment. The validation of these scales across diverse patient populations has demonstrated varying degrees of reliability and clinical utility. Current evidence suggests that while traditional subjective scales remain clinically relevant, objective measurement systems provide superior repeatability and may better serve research applications requiring precise quantification of inflammatory changes. This review summarizes current knowledge regarding conjunctival inflammation grading methodologies and provides insights into novel developments in the field.<\/jats:p>","DOI":"10.3390\/diagnostics15243200","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"3200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Grading Scales of Conjunctival Inflammation"],"prefix":"10.3390","volume":"15","author":[{"given":"Anca-Elena","family":"Anghelache-Dobrescu","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian-Eduard","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2429-7936","authenticated-orcid":false,"given":"Radu-Gheorghe","family":"Buc\u0219an","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Garh\u00f6fer","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-6571","authenticated-orcid":false,"given":"Alina","family":"Popa-Cherecheanu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopold","family":"Schmetterer","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"},{"name":"SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 637553, Singapore"},{"name":"School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"Centre for Medical Physics and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore"},{"name":"Fondation Ophtalmologique Adolphe De Rothschild, 75019 Paris, France"},{"name":"Aier Eye Hospital Group, Changsha 410005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-6112","authenticated-orcid":false,"given":"Alina Gabriela","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Clinical Institute of Ophthalmological Emergencies \u2018Prof. Dr. Mircea Olteanu\u2019, 010464 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jtos.2021.05.003","article-title":"Ocular redness\u2014I: Etiology, pathogenesis, and assessment of conjunctival hyperemia","volume":"21","author":"Singh","year":"2021","journal-title":"Ocul. 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