RESEARCH PAPER Grading of tarsal conjunctiva of young adults in Malaysia Clin Exp Optom 2011; 94: 5: 458–463 DOI:10.1111/j.1444-0938.2011.00621.x Bashirah Ishak BOptom(Hons) MSc Bariah Mohd-Ali BOptom(Hons) PhD Norhani Mohidin BOptom MOptom PhD Optometry, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia E-mail: bariah@medic.ukm.my 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 r= 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. Conclusion: 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. Submitted: 3 September 2010 Revised: 14 February 2011 Accepted for publication: 26 February 2011 Key words: conjunctiva, contact lenses, Malaysia Previous studies have shown that changes in the upper tarsal conjunctiva occur in both soft and rigid gas permeable lens wear after a period of wearing. 1 These changes are among the major complications accom- panying contact lens wear, which can lead to induced papillary conjunctivitis as a consequence of allergenic stimuli and mechanical irritation. 1,2 Contact lens solu- tions have also been implicated. 3 Better knowledge of the characteristics of the appearance of normal tarsal con- junctiva will improve the detection and management of contact lens-induced com- plications. The appearance of normal tarsal conjunctiva receives less attention because most researchers look at the changes associated with ocular disease and CLINICAL AND EXPERIMENTAL OPTOMETRY Clinical and Experimental Optometry 94.5 September 2011 © 2011 The Authors 458 Clinical and Experimental Optometry © 2011 Optometrists Association Australia