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Inflammation of one or both structures is relatively uncommon but easily diagnosed by comparison with Figure 9. Either is used in the clinical activity score (CAS): only recently was their differentiation appreciated.

Fig. 8. Assessment of chemosis. a Normal appearance (conjunctivochalasis). Separation of reflections from conjunctiva and sclera (black arrow) are ≤1/3 total height of palpebral aperture. b Chemosis. The white arrow shows separation of conjunctival and scleral reflections >1/3 total height of palpebral aperture.

Fig. 9. Inflammation of the caruncle and/or plica. Note the difference in colour between the normal caruncle (a) and the inflamed caruncle (b). Exophthalmos causes the caruncle to prolapse forwards but does not denote caruncle inflammation.