This study aimed to develop the Scale for Ophthalmoplegia in Brain-Injured Patients (SOB) and assess its reliability and validity. The SOB was developed using methods extracted from a prior systematic review and refined through an expert consensus process. The scale consists of five items and has a maximum score of nine points. Cronbach's alpha coefficient was calculated to assess internal consistency. Four occupational therapists from acute care hospitals, with varying clinical experience, evaluated 20 patients with brain injury and external ophthalmoplegia to assess intra- and inter-examiner reliability. Criterion-related validity was assessed by correlating SOB scores with the Hess red-green test. The average time to evaluate each case using the SOB was 48.0 ± 9.2 s. Cronbach's alpha coefficient was 0.72, indicating a moderate level of consistency. Intra-class correlation coefficients, ICC(1, 1), for intra-examiner reliability were good: A, 0.979; B, 0.903; C, 0.895; and D, 0.795. ICC(2, 1) for inter-examiner reliability indicated good agreement between the first (0.861) and second (0.835) evaluations. Criterion validity showed a significant correlation between SOB and the Hess red-green test (ρ = 0.783–0.947, p < 0.05). The SOB is a brief, reliable, and valid scale for assessing external ophthalmoplegia in patients with brain injury. It has high intra- and inter-examiner reliability, including criterion-related validity, supporting its use as a screening tool that should be widely adopted in clinical practice.

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