A Study of Efficacy of Rose Bengal and Lissamine Green Stain in Dry Eyes

Abstract

Background: Ocular vital dyes are part of determining the disease of dry eye (DED). Rose bengal (RB) and lissamine green (LG) vary in the tolerability of patients and cell-interaction, but comparative, practice-based evidence presented in regular clinics is useful. It was a cross-sectional study of staining efficacy and tolerability of RB and LG in a hospital setting and based on the Van Bijsterveld scale. Methods: Individuals with DED who are adults (>=18 years old) and visit two tertiary centers were recruited (n=64). The exclusion criteria were dye hypersensitivity or lack of consent. One group ( A ) consisted of consecutive users, and the other one ( B ) involved sequential users. The findings were demographics, I (no anesthesia) with slit-lamp. The main outcomes included (i) patient-reported tolerability (with no complaint vs irritation/burning/itching/stinging), (ii) observational sensitivity by Van Bijsterveld intensity (mild/moderate/severe) and (iii) anterior chamber penetration. Such statistics encompassed t-tests and Chi-square. Results: There was no difference in the mean age between the groups (LG 44.31±13.56 vs RB 45.29±12.80 years; p=0.76). The distribution of sex was comparable (p=0.45). Tolerability was significantly improved between LG and RB (no complaints 84.37 vs 37.50). RB has reported a moderate-to-severe intensity staining (13/9/10 counts=mild/moderate/severe) in comparison with LG (25/7/0); chi-square=14.04, p=0.0008). There was no anterior chamber penetration in any case of either group (0%). Another finding was that blood pressure and random blood glucose were similar among groups (p>0.05). Conclusion: Under normal conditions of DED practice, LG offers significantly more patient-friendly without reducing the detection in mild-moderate disease, but RB more effectively shows higher-intensity staining but at the expense of a very high level of discomfort. The results correlate with the experimental evidence that RB is more cytotoxic/irritating, whereas LG is more tolerable and is advised in any existing diagnostic algorithm. Through pragmatic means LG is better to be used in the first line of ocular surface staining leaving RB to certain situations whereby there is the need to detect severe epithelium in the form of keratinized/devitalized epithelium.