title: Grading of tarsal conjunctiva of young adults in Malaysia.
abstract: BACKGROUND
  The monitoring and assessment of the upper tarsal conjunctiva can be enhanced by the use of a grading scale. The aim of this study was to categorise the appearance of normal tarsal conjunctiva among young adults in Malaysia using the Institute for Eye Research grading scale and to investigate inter- and intra-observer agreement.
  
  
  METHODS
  The appearance of the upper tarsal conjunctiva of 416 non-contact lens wearing subjects aged between 19 to 24 years was assessed by two separate observers for roughness and redness in three separate zones using the Institute for Eye Research grading scale. The average grade for each zone and overall grade for roughness and redness were calculated. Inter- and intra-observer agreements were analysed.
  
  
  RESULTS
  Subjects were categorised for ethnicity and the roughness and redness were calculated. No significant differences were found between Malay and Chinese eyes (p > 0.05). The average grades for the upper tarsal conjunctiva redness and roughness were 0.90 ± 0.25 and 0.86 ± 0.43, respectively. Significantly higher roughness scores were found in zone 1 compared to the other two zones (p = 0.03). Significant association was also found between tarsal conjunctiva redness and roughness (Spearman ρ= 0.45, p < 0.001). Correlation between redness and roughness with age (p = 0.48, p = 0.65) and gender (p = 0.30, p = 0.79) were not significant. Only 2.2 per cent of subjects had scores higher than 2.0 for roughness or redness. Inter- and intra-observer analysis showed good agreement between two observers during the study.
  
  
  CONCLUSIONS
  The roughness and redness of normal tarsal conjunctiva among young adults in Malaysia were found to be less than two units. Results of this study might be beneficial in clinical trials using contact lenses where changes in the tarsal conjunctiva are commonly used as an outcome measure.
authors.affiliation: Optometry, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Bashirah
authors.initials: B
authors.lastname: Ishak
authors.forename: Bariah
authors.initials: B
authors.lastname: Mohd-Ali
authors.forename: Norhani
authors.initials: N
authors.lastname: Mohidin
mesh_terms: D044466:Asian People; D003228:Conjunctiva / Q000033:anatomy & histology* / Q000473:pathology*; D003229:Conjunctival Diseases / Q000208:ethnology / Q000473:pathology*; D003261:Contact Lenses / Q000009:adverse effects; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results; D055815:Young Adult