Patient Tolerance and Ocular Surface Staining Characteristics of Lissamine Green versus Rose Bengal

doi:10.1016/S0161-6420(95)30769-5

Ophthalmology

Volume 102, Issue 12, December 1995, Pages 1953-1957

https://doi.org/10.1016/S0161-6420(95)30769-5 Get rights and content

Abstract

Purpose: To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green versus 1% rose bengal solutions in patients with dry eye and in those with normal ocular surfaces by comparison of subjective sensation and objective staining scores.

Methods: Twelve patients with keratoconjunctivitis sicca and eight subjects with no ocular surface disease recorded their symptoms on a graded scale (0-5) and the duration of symptoms after instillation of one drop of 1% lissamine green and 1% rose bengal on two different occasions in different order. Lissamine green and rose bengal staining patterns were recorded on a graded scale (0-4) by one of the authors.

Results: For patients with keratoconjunctivitis sicca mean sensation score with lissamine green (2.42) was significantly lower (P= 0.00006) than with rose bengal (4.58). The duration of symptoms was significantly longer (P= 0.0007) after rose bengal instillation as well. For subjects with no ocular surface disease, mean sensation score with Lissamine green (1.375) was significantly lower (P= 0.01) than with rose bengal (2.5). In this group, duration of symptoms also was significantly longer (P= 0.001) after rose bengal instillation. In both groups, there was no difference in objective staining scores.

Conclusion: Lissamine green is better tolerated than rose bengal by patients and is equally as effective as rose bengal in evaluating the ocular surface in keratoconjunctivitis sicca.

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Vital staining of the ocular surface with fluorescein has been used clinically for over 100 years to assess corneal damage and to diagnose and monitor the progression of dry eye disease (DED) [1–3]. In the past, rose bengal was routinely used to assess conjunctival staining in DED, but it has recently been replaced by lissamine green due to the toxicity [4–6] and discomfort [7–10] produced by rose bengal. Fluorescein and lissamine green are now considered standard dyes for assessing ocular surface health in DED and are frequently used as important endpoints in clinical trials [11,12].
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Vital dye staining has been used for over a century to assess the severity of ocular surface disease. However, despite common usage, a universally accepted “gold standard” grading scale does not exist for corneal and conjunctival staining, which can impact the ability to diagnose and monitor ocular surface conditions such as dry eye. The Food and Drug Administration (FDA) and other international regulatory agencies rely on ocular surface staining as a primary endpoint for new drug approvals, so that absence of a “gold standard” scale may affect approval of new drug treatments. To begin to address this problem, we review existing, published grading scales in an integrated fashion, highlighting their differences and similarities to emphasize common themes and the methods and elements that are important in creating a standardized scale. Our goal is to aid the field in moving towards an accepted standardized grading scale for ocular surface staining that can be applied in clinic and research settings for a variety of ocular conditions.

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^*: Presented as a poster at the American Academy of Ophthalmology Annual Meeting, San Francisco, Oct/Nov 1994.

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Patient Tolerance and Ocular Surface Staining Characteristics of Lissamine Green versus Rose Bengal*

Abstract

Ophthalmology

Am J Ophthalmol

Semin Arthritis Rheum

J Autoimmun

Food Chem Toxicol

Food Chem Toxicol

Food Chem Toxicol

Food Chem Toxicol

Zur Kenntnis der Keratoconjunctivitis Sicca (Keratitis filiformis bei Hypofunktion der Tranendrusen)

Acta Ophthalmol Suppl

Vital staining of conjunctiva and cornea. Review of literature and critical study of certain dyes

Arch Ophthalmol

Vital staining of cornea and conjunctiva

Acta Ophthalmol

Specific double vital staining of the cornea and conjunctiva with rose bengal and alcian blue

Acta Ophthalmol

Trypan blue. Vital staining of cornea and conjunctiva

Acta Ophthalmol

Dead, degenerate, and living cells in conjunctival fluid and mucous thread

Acta Ophthalmol

Rose bengal vital staining. Staining of cornea and conjunctiva by 10% rose bengal, compared with 1%

Acta Ophthalmol

What is actually stained by rose bengal?

Arch Ophthalmol

The antiviral effects of rose bengal and fluorescein

Arch Ophthalmol