To evaluate the high-speed anterior segment optical coherence tomography (AS-OCT) grading of the AS inflammation in patients with ocular inflammation. A retrospective consecutive case series study. Patients with clinically visible AS inflammation in at least one eye underwent AS-OCT (Visante; Zeiss Meditec) with three to eight line scans per eye, performed by a trained masked examiner. The images were reviewed for hyperreflective spots, noise, and artifact, and these were correlated to clinical examination. Seventy-eight eyes of 41 patients were imaged. Forty-seven eyes had anterior chamber cells on clinical examination, and 68 had hyperreflective spots visible on AS-OCT. There was a significant correlation (Spearman r = 0.7274) between clinical examination and Visante OCT images. Several patterns of inflammation and artifacts were apparent. The AS-OCT is a promising technique for grading anterior chamber cells. There was a significant correlation between clinical examination and Visante grading.