Over the whole area of the tarsal conjunctiva there are normally large deep-lying blood vessels that run vertically. Follicles are round swellings that are paler than the sorrounding conjunctiva, appearing white, grey or yellow. Follicles must be at least 0.5mm in diameter to be considered. The tarsal conjunctiva appears red, rough and thickened. There are usually numerous follicles, which may be partially or totally covered by the thickened conjunctiva.
Scars are easily visible as white lines, bands, or sheets in the tarsal conjunctiva.
They are glistening and fibrous in appearance. Scarring, especially diffuse fibrosis, may obscure the tarsal blood vessels. Evidence of recent removal of inturned eyelashes should also be graded as trichiasis. The pupil margin is blurred viewed through the opacity.