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Whitcher JP, Shiboski CH, Shiboski SC, et al; Sjögren's International Collaborative Clinical Alliance Research Groups. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry. Am J Ophthalmol. 2010 Mar;149(3):405-15. 

Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification.

Serologic Markers Are Associated With Ocular Staining Score in Primary Sjögren Syndrome

Outcome Measures in Primary Sjögren's Syndrome

The OSS is an ocular surface staining score used to objectively assess the severity of keratoconjunctivitis sicca (KCS).

The OSS includes two domains: the corneal fluorescein staining pattern and the conjunctival lissamine green staining pattern.

Administration of the OSS can be performed by experienced ophthalmologists or optometrists.

The total OSS for each eye is the summation of the fluorescein score for the cornea and the lissamine green scores for the nasal and temporal bulbar conjunctivae.

-Corneal fluorescein staining pattern: Each cornea is examined. Punctate epithelial erosions (PEEs) are counted and scored as follows: no PEE, score is 0; 1 to 5 PEEs, score is 1; 6 to 30 PEEs, score is 2; and more than 30 PEEs, score is 3. An additional point is added if 1) the PEE occurred in the central portion of the cornea, 2) one or more filaments are seen, or 3) one or more patches of confluent staining are found anywhere on the cornea. The total score for the cornea is the sum. The maximum possible score for each cornea is 6.

-Conjunctival lissamine green staining pattern. The interpalpebral bulbar conjunctivae are examined after staining. Nasal and temporal conjunctivae are graded separately, with a maximum score of 3 for each area or a total maximum score of 6 for each eye. Grade 0 is defined as 0 to 9 dots; grade 1, 10 to 32 dots; grade 2, 33 to 100 dots; and grade 3, more than 100 dots