Sotozono et al developed a grading systems for chronic ocular changes associated with Stevens-Johnson Syndrome (SJS). The score can also be used in other cicatricial disorders affecting the ocular surface. The authors are from Kyoto Prefectural University, Keio University, Tokyo Dental College and National Tokyo Medical Center.
Parameters (by location):
(1) superficial punctate keratopathy (corneal)
(2) corneal epithelial defect (corneal)
(3) loss of the Palisades of Vogt (corneal)
(4) conjunctivalization (corneal)
(5) corneal neovascularization (corneal)
(6) corneal opacification (corneal)
(7) corneal keratinization (corneal)
(8) conjunctival hyperemia (conjunctival)
(9) symblepharon formation (conjunctival) = an adhesion between the bulbar and tarsal conjunctivae
(10) trichiasis (eyelid) = ingrowing eyelashes
(11) mucocutaneous junction involvement (eyelid)
(12) Meibomian gland involvement (eyelid)
(13) punctal involvement (eyelid)
|
Parameter |
Finding |
Points |
|---|---|---|
|
superficial punctate keratopathy |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
corneal epithelial defect |
none |
0 |
|
|
less than one quarter of corneal surface |
1 |
|
|
involves one quarter to one half of the corneal surface |
2 |
|
|
involves more than one half of the corneal surface |
3 |
|
loss of the Palisades of Vogt (POV) |
no loss |
0 |
|
|
loss of less than half of the total circumference |
1 |
|
|
loss of more than half of the total circumference |
2 |
|
|
total loss of the POV |
3 |
|
conjunctivalization |
none |
0 |
|
|
involves less than a quarter of the corneal surface |
1 |
|
|
involves one quarter to one half of the corneal surface |
2 |
|
|
involves more than half of the corneal surface |
3 |
|
corneal neovascularization |
none |
0 |
|
|
confined to corneal periphery |
1 |
|
|
extends to edge of the pupil, sparing the central cornea |
2 |
|
|
involves the central cornea |
3 |
|
corneal opacification |
cornea clear |
0 |
|
|
iris details partially obscured |
1 |
|
|
iris details poorly visible |
2 |
|
|
iris and pupil completely obscured |
3 |
|
corneal keratinization |
none |
0 |
|
|
involves less than a quarter of the corneal surface |
1 |
|
|
involves one quarter to half of the corneal surface |
2 |
|
|
involves more than half of the corneal surface |
3 |
|
conjunctival hyperemia |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
symblepharon formation |
none |
0 |
|
|
on the conjunctival surface only |
1 |
|
|
involves less than half of the corneal surface |
2 |
|
|
involves more than half of the corneal surface |
3 |
|
trichiasis |
none |
0 |
|
|
involves less than one quarter of the lid margin |
1 |
|
|
involves from one quarter to one half of the lid margin |
2 |
|
|
involves more than one half of the lid margin |
3 |
|
mucocutaneous junction involvement |
normal |
0 |
|
|
mild irregularities |
1 |
|
|
moderate irregularities |
2 |
|
|
severe irregularities |
3 |
|
Meibomian gland involvement |
clear oily fluid |
0 |
|
|
yellowish-white oily fluid |
1 |
|
|
thick, cheesy material |
2 |
|
|
unable to express any material |
3 |
|
punctal damage and occlusion |
none (normal, patent) |
0 |
|
|
iatrogenic occlusion (by plugs or suture) |
1 |
|
|
either super or inferior occluded by scarring |
2 |
|
|
both superior and inferior occluded by scarring |
3 |
where:
• Superficial punctate keratopathy was graded based on area involved and density using the method of Miyata et al. A1D1 was Grade 0, A1D2 or A2D1 Grade 1, A2D2 or A1D3 or A3D1 Grade 2, and A2D3 or A3D2 or A3D3 Grade 3.
total score =
= SUM(points for all 13 paramters)
Interpretation:
• minimum score: 0
• maximum score: 39
• The higher the score the more severe the involvement.
Specialty: Ophthalmology, Dermatology, Immunology/Rheumatology, Pharmacology, clinical
