Frisen Scale (Papilledema Grading)
The FRISEN SCALE (Frisen 1982) grades swelling of the optic nerve head 0 to 5 on fundus appearance: grade 0 = No C-shaped halo and no obscuration of the peripapillary nerve fiber layer.
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Example
- The peripapillary halo
- The halo is circumferential - the temporal gap is filled in
- Total obscuration of a portion of at least one major vessel AS IT LEAVES the…
- Yes
- Total obscuration of a portion of at least one major vessel ON the disc
- No
- A segment of EVERY major vessel is totally obscured
- No
Result: 3
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What the result means
- Grade 0
- No C-shaped halo and no obscuration of the peripapillary nerve fiber layer.
- Grade 1
- C-shaped halo with scalloped or feathered borders and a TEMPORAL GAP obscuring underlying retinal detail.
- Grade 2
- The halo is circumferential - the temporal gap is filled in. Partial obscuration of major vessels is PERMITTED.
- Grade 3
- Grade 2 plus TOTAL obscuration of a portion of at least one major vessel AS IT LEAVES the disc.
- Grade 4
- Grade 3 plus total obscuration of a portion of a major vessel ON the disc, with at least one vessel on the disc SPARED.
- Grade 5
- Grade 4 with total obscuration of a segment of EVERY major vessel. None is spared.
- The gap
- The temporal gap is the WHOLE difference between grades 1 and 2. It exists because the temporal border is spared, its axons being of fine caliber.
- 3 versus 4
- They differ by WHERE the obscured vessel is, not how much is obscured: leaving the disc versus on the disc.
- 4 versus 5
- Grade 4 is defined by an EXCEPTION - one vessel spared. If none is spared it is grade 5.
- Partial
- Partial obscuration does NOT qualify for grade 3 or above. Treating it as qualifying raises the grade.
- Not pressure
- THE GRADE DOES NOT MEASURE INTRACRANIAL PRESSURE. A low grade does not exclude raised pressure and a high grade is not a pressure value.
- Scope
- Grades a disc appearance. Does not diagnose, does not separate true papilledema from pseudopapilledema, and does not decide imaging, lumbar puncture or treatment.
What you enter
- The peripapillary halo.
- Total obscuration of a portion of at least one major vessel AS IT LEAVES the disc.
- Total obscuration of a portion of at least one major vessel ON the disc.
- A segment of EVERY major vessel is totally obscured - none is spared.
Full field descriptions
- The peripapillary halo [none = No C-shaped halo and no obscuration of the peripapillary nerve fiber layer; temporal-gap = C-shaped halo with scalloped or feathered borders and a TEMPORAL GAP; circumferential = The halo is circumferential - the temporal gap is filled in]. "temporal-gap" is grade 1 and "circumferential" is grade 2 or above.
- Total obscuration of a portion of at least one major vessel AS IT LEAVES the disc. TOTAL obscuration only - partial obscuration does not count.
- Total obscuration of a portion of at least one major vessel ON the disc. TOTAL obscuration only - partial obscuration does not count.
- A segment of EVERY major vessel is totally obscured - none is spared. TOTAL obscuration only - partial obscuration does not count.
How this is calculated
- Structure
- CUMULATIVE: each grade requires the features of the one below. The published wording is "features of grade 2 plus...".
Frisen L. Swelling of the optic nerve head: a staging scheme. J Neurol Neurosurg Psychiatry. 1982;45(1):13-18. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.