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Global Journal of Cataract Surgery and Research in

Ophthalmology

Review Article

Stains and dyes in Ophthalmology

Ranjit S. Dhaliwal1, Kunwar Vikram S. Dhaliwal1, Mohini Singh2, Atul Kakkar3
Eye Infirmary, Nabha, Punjab, India, 2Drug Safety, Parexel International, 3Kakkar Eye Hospital, Patiala, Punjab, India.
1

ABSTRACT
Stains and dyes are very effective diagnostic and therapeutic tools in ophthalmology. Although non-invasive, diagnostic dyes are objectively used to
directly visualize, identify and track microscopic ocular structures for anterior, as also posterior segment disorders. These are very useful, both for
anterior and posterior segment disorders. Diagnosis and management of retinal vascular disorders have been revolutionised, ever since the introduction
of fluorescein. It is used in an array of disorders of the anterior segment also. The term staining is used to describe epithelial disruption and other
pathophysiological changes which can be seen when we use the dyes topically. The dyes used topically are called vital stains.

Keywords: Stains, Dyes, Ophthalmology

INTRODUCTION years, the experience with the dyes has progressed, with
Stains and dyes are effective diagnostic and therapeutic newer dyes still being tested in various medical laboratories.
tools in Ophthalmology. Although non-invasive, diagnostic Laboratories conduct pre-clinical investigations with reliable
dyes are objectively used to directly visualise, identify and methods to study the toxicity of the dyes and these studies
track microscopic ocular structures for anterior, as also include functional, histological and biochemical analysis. The
posterior segment disorders. Diagnosis and management of anterior segment analysis includes cell culture, specular and
retinal vascular disorders have been revolutionised with the confocal microscopy. Retinal cell culture, electrophysiological
introduction of fluorescein. It is used in the disorders of the tests and angiographic studies are conducted for posterior
anterior segment also.[1] Staining is used to describe epithelial segment analysis.[6-11] Vital stains are used to visualise tissues
disruption and other pathophysiological changes using the in the living state.[12]
dyes topically. Topically used dyes are called vital stains.[2] Pfluger first described and used sodium fluorescein, often
referred to as fluorescein to stain cornea and conjunctiva
HISTORICAL PERSPECTIVE in rabbits in the 1882.[13] Henrik Sjögren introduced Rose
Certain chemical compounds attach to various other natural Bengal (RB) in 1933. Till then, fluorescein was in fact
materials and visually brighten them up by giving them a the primary dye used to stain the conjunctiva.[14] Mogens
specific colour. All living tissues and cells take up colours of Norn introduced Lissamine Green (LG), a vital stain with
vital dyes, which are thus considered important surgical tools, properties almost identical to those of RB[15] in 1973.
to visualise the ocular tissues. Hoffer and McFarland, 1993, Many questions still remain unanswered as to how to use the
used the biocompatible dye fluorescein to stain the anterior dyes to achieve the best results with minimum toxicity to the
capsule for capsulorhexis in mature cataracts.[3] Subsequently, tissues. Information about some of the vital dyes is presented
the use of vital dyes in cataract surgery has been widely in this article.
reported. The use of a vital dye during vitreoretinal (VR)
surgery was first reported by Abrams et al.[4] in 1978, as a CLINICAL USE AND METHODOLOGY
very useful aid in identifying vitreous. Chromovitrectomy is
The use of vital stains and dyes goes beyond the dry eye
widely used since the year 2000.
to innumerable other surface disorders of the cornea and
Trypan blue has been used to stain the anterior capsule blue conjunctiva. The three most commonly used dyes today are
to make the procedure of capsulorhexis easier.[5] In the recent fluorescein, RB and LG.[16]

*Corresponding author: Ranjit S. Dhaliwal, Eye Infirmary, Nabha, Punjab, India. [email protected]
Received: 24 June 2022 Accepted: 27 August 2022 Published: 21 September 2022 DOI: 10.25259/GJCSRO_5_2022

is is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon
the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. ©2022 Published by Scientific Scholar on behalf of Global Journal of
Cataract Surgery and Research in Ophthalmology

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 Dhaliwal, et al.: Stains and dyes in Ophthalmology

Fluorescein is used to stain cornea, while LG or RB is used DYES USED IN OPHTHALMIC SURGERY
to stain conjunctiva. Individually wrapped, sterile dye- Proper exposure and visualisation when performing corneal,
impregnated paper strips are used in clinical practice for cataract and retinal procedures, often taken for granted
staining the tissues. To apply fluorescein dye to cornea, because eye is readily accessible and the pathology can be
the tip of the sterile paper strip is used after wetting with a seen directly, are important for ophthalmic surgery. Clouding
drop of sterile saline. The patient looks up and the inferior of the ocular media can interfere with the quality of our view
palpebral or bulbar conjunctiva is touched with the tip of during all intraocular surgical manipulations. Ophthalmic
the strip. Inferior palpebral conjunctiva is preferred to avoid surgical dyes are valuable tools, used both for anterior and
Bell’s phenomenon, the normal reflex of upward and outward posterior segment indications.[1]
movement of the eye observed during a blink or when we
Dyes are designated vital when used to stain living cells or
approach the eye.[17]
tissues. Vital dyes are useful and effective surgical tools for
In severe dry eye having a reduced tear volume, dye is instilled identifying ocular tissues.[1]
on the superior bulbar conjunctiva, from where it gets
distributed all over with gravity. Never apply the impregnated CATARACT SURGERY
paper strip to the cornea, to avoid corneal abrasions. The continuous curvilinear capsulorhexis is one of the most
In laboratories, a pipette is used for instilling vital stains difficult as well as most critical steps in modern cataract
obtained in preservative free bottles from pharmacies instead surgery. A proper capsulorhexis helps stabilise the IOL
of paper strips, to avoid variability of dye concentration and implant centrally in the proper position and protects from
volume applied to the ocular surface.[18] In clinical practice, radial tears of the capsular bag. A red reflex is necessary
however, preservative-free bottles of vital stains are avoided, for the surgeon to see the leading edge of the curvilinear
to prevent the risk of growth of Pseudomonas aeruginosa.[19] capsulorhexis with retroillumination as he proceeds with the
capsulorhexis. The capsulorhexis edge cannot be seen or can
The tissues stained should be evaluated after a definite period be seen with great difficulty, if the red reflex is poor or absent.
after instillation of the dye, for variable staining occurs, if the In a mature cataract, there is no red reflex and the milky fluid
time of instillation and observation varies.[20,21] An assessment cortex escaping into the anterior chamber further clouds an
made too soon or too late after instillation of the dye to assess already poor view of the anterior lens capsule. Hence, before
staining is avoided, for this will result in a staining score that the era of capsular dyes, it used to be a struggle to complete
is lower than the maximum staining potential. Staining is the capsulorhexis under such circumstances and would many
best observed at least 1–2 hours after the insertion of contact a times need a conversion to a can opener capsulotomy.[1]
lenses, if solution toxicity or lens/solution interactions are
Capsular dyes have improved our surgical ability to perform
suspected.[22]
the capsulorhexis under these circumstances. In fact, the
On slit-lamp examination, the pattern of the staining problem of visualising the capsule has been eliminated.
observed is always saved with slit-lamp photographs. How About 0.06% ophthalmic solution of trypan blue has been
much stain was present and what type of dye was used is approved by FDA for intraocular surgery and is available in
also noted down. The characteristics of staining that is noted ready-to-use preloaded syringes for cataract procedures. The
down should include the pattern (focal, diffuse, punctate or dye is injected into the anterior chamber under an air bubble,
coalesced), position (superior, inferior, nasal, temporal or over the anterior lens capsule. This stains the capsule blue and
central), depth (superficial or deep) and grade (none, trace, makes it clearly identifiable throughout surgery. In addition
mild, moderate and severe) of the staining. to cases of poor red reflex, capsular dyes are very helpful in
cases of weak zonules. Capsule-related complications are
DYES TO AID POSTERIOR SEGMENT reduced with the use of dye, because any radial tear or shift
DIAGNOSTICS AND EVALUATION of the capsular bag can be well distinguished from the clearly
outlined capsulorhexis.[1]
Fluorescein is used in photographic imaging of the retinal
vasculature during fundus fluorescein angiography. The Triamcinolone is used if a posterior capsular rent occurs
dye, sodium fluorescein, is used in concentrations of 10% during cataract surgery, to make out vitreous strands left in
or 20% in the form of bolus intravenous injection. It is used the anterior chamber, after anterior vitrectomy.[1]
to image retinal, choroidal, optic disc or iris vasculature or a
combination of these, for diagnosis and in planning for many CORNEAL SURGERIES
retinal laser procedures. It is used in the management of About 0.06% trypan blue is also used to stain Descemet’s
diabetic retinopathy, vein occlusions and age-related macular membrane during Descemet’s stripping endothelial
degeneration and diagnosis of macular ischaemia.[1] keratoplasty. Its use in staining and stripping the endothelium

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 Dhaliwal, et al.: Stains and dyes in Ophthalmology

from the donor lenticule in deep anterior lamellar toxicity for the retina and the retinal pigment epithelium has
keratoplasty[1] is also well documented. been observed to be absent.[24]
Trypan blue also helps in enhancing the visibility of edges
RETINAL SURGERIES of ruptures within the surgery of rhegmatogenous retinal
Trypan blue is an aid for posterior segment surgeons and detachment.[25] The staining with trypan blue is enhanced, by
is used for retinal procedures. Visualisation of membranes injecting it at the posterior pole under air or by mixing it with
overlying the retina is difficult at times; here, trypan blue 5–10% glucose to form a dye that is heavier and denser than
0.15% ophthalmic solution is useful for identifying and balanced salt solution.[26,27] A 0.3 ml of trypan blue is mixed
delineating these to allow their complete removal. The with 0.1 ml, 10% glucose, for creating a 1 mg/ml (0.1%)
dye is used to stain the posterior hyaloid, internal limiting solution and osmolality of 300 mOsm. Trypan blue usage
membrane (ILM) and epiretinal membranes blue, thus is usually recommended mainly for epiretinal membrane
making these structures visible against the unstained retina. staining.[28,29] In low doses, trypan blue neither incites any
This facilitates and makes macular hole and macular pucker inflammation and corneal toxicity in the anterior chamber
surgery safer. The dye is injected under air after fluid air usage nor any retinal toxicity in ERM surgery.
exchange, to stain the pre-retinal membranes and ILM.[1]
In eye surgery, there is no need to struggle with poor LISSAMINE GREEN
visualisation any more. Trypan blue is readily available, • Acidic
simple to use, extremely effective and now has a well- • Synthetically produced, and an organic dye that has been
established role. employed in food products previously[30,31]
• Synonyms include acid green S, wool green S or C and
CHEMICAL STRUCTURE-BASED fast light green
CLASSIFICATION • Carcinogenicity and toxicity studies previously are
shown to be unexceptional and have demonstrated a
When vital staining is done within a living being, it is
wonderful safety profile[16]
known as intravital staining. Most of the dyes are organic
• The staining profiles of LG and RB have been
compounds having aromatic series, derivatives of benzene
demonstrated to be comparable
(C6H6). Chromogen is the greater molecule to which this
• LG irritates less and is better tolerated.[16,32,33]
benzene ring is attached to absorb visible light. The property
of colour of the chromogen is due to chromophore. The Ocular surface epithelial cells unprotected by mucin or
various dyes currently available may be classified according glycocalyx, and cells that have been damaged are stained by
to their pH, solubility and source and staining property. LG. However, unlike RB, it does not inhibit viral replication
Chemical structure of the dye determines the colour and in vivo.[16,33-35] Although, RB stains proliferating corneal
properties of dyes and provides a basis of a classification. The epithelial cells and affects their viability,[36] LG does not.
capacity of staining depends on many different factors, such Better patient tolerance and non-toxic effect of LG makes
as geometry and microtopography of the cells and tissues, or it better than RB in evaluating ocular surface disorders and
preparation of the specimen [Table 1]. have been shown to be sensitive and specific.[37,38]
With the introduction of LG, clinical reports have shown its
TRYPAN BLUE use as a stain to diagnose ocular surface disease. Dead and
• Highly hydrophilic tetrasulphonated anionic azo dye degenerated cells are stained with LG, while it does not stain
• C34H24N6Na4O14S4 healthy epithelial cells.[39] This dye is not related to stinging
• Molecular weight of 960.79 Da or discomfort at 1% concentration, and there are no reports
• Synonyms: Direct blue 14, diamine blue 3B and Niagara of any toxicity. LG is tolerated by patients better than RB,
blue 3B. though studies have shown that both these dyes have similar
It consists of a bigger planar aromatic system and has a staining profiles.[20,33] Our priority for staining the bulbar
lipophilic domain between sulphonated naphthyl end units. conjunctiva is LG. Furthermore, LG staining will detect the
The nuclei of damaged and dead endothelial cells in donor dry eye early. A study at Southwestern Medical Center,[40]
cornea are stained with this, and it is widely utilised in both The University of Texas describes three staining patterns
vitrectomy and cataract surgery. It is commercially available which will indicate the progression of severity levels in an
in a concentration of 0.15% for VR surgery and 0.06% for exceedingly dry eye:
cataract surgery. Low doses of trypan blue do not induce • First, the nasal conjunctiva stains
inflammation and corneal toxicity when injected into the • Then, the nasal and temporal conjunctiva stain and
anterior chamber.[1,23] In most studies with trypan blue, • Finally, the cornea, nasal and temporal conjunctiva stain.

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 Dhaliwal, et al.: Stains and dyes in Ophthalmology

Table 1: Dyes, chemical groups, indications and toxicity in ophthalmic use.

Group Chemistry Dyes Concentration (%) Indication Toxicity
Azo dyes Benzene as Trypan blue 0.15 for VR and 0.06 Vitreoretinal and Low doses do not
aromatic ring for cataract surgery cataract surgery incite inflammation
or toxicity
Janus green B Assess corneal Not used
endothelial cell intraocularly
viability
Arylmethane Carbon linked to 2 Gentian violet 0.001–2 Anterior capsule Endothelial toxicity
dyes benzene groups visualisation; marker
for cornea and
conjunctiva
Bromophenol blue 0.02–2 VR surgery and No cellular toxicity
anterior capsule noted
staining
Patent blue 0.24 VR and cataract Conflicting results of
surgery toxicity profiles
Brilliant blue 0.25 VR surgery No cellular toxicity
noted
Light green 10–20 in water; Collagen in histological No cellular toxicity
0.2–4 in ethanol sections noted
Fast green 6 in water; 0.5 in VR and cataract Safe intraocular
ethanol surgery profiles
Lissamine green 1 Corneal and Less irritating and
conjunctival staining in toxic than Rose
dry eye evaluation Bengal
Cyanide dyes One or more Indocyanine green 0.5 VR and cataract Retinal damage,
methine groups surgery RPE toxicity, optic
atrophy, visual field
defects
Thiazine dyes Ring of 4 carbon, Methylene blue 1 Ocular surface Severe endothelial
1 nitrogen and 1 toluidine blue neoplasia (histological decompensation
sulphur atom staining)
Xanthene 2 aryl rings Fluorescein 2 Ocular surface, Up to 10% conc.
dyes bridged with sodium fluorescein showed no toxicity
oxygen atom angiography, VR and on endothelium
cataract surgery
Rose Bengal 0.5–1 Diagnosing ocular Stinging,
surface disorders dose‑dependent
ocular surface
toxicity
Rhodamine 6G 0.0002–0.02 VR and cataract Dose‑dependent
surgery intraocular toxicity
VR: Vitreoretinal

Staining the conjunctiva with LG is beneficial in evaluation typically asymptomatic, and therefore, the conjunctival
of, both the dry eye patients and contact lens wearers. surface is generally clear.
Circumlimbal corneal staining is observed with LG. This LG additionally helps evaluate the superior and inferior
is often an indicator of lens-induced conjunctival staining, eyelid margins for lid wiper epitheliopathy in patients with
showing that the lens is either too tight or encompasses a dry eye symptoms in the absence of dry eye findings. It is
sharp edge. This means refitting the patient with a special useful in diagnosing keratoconjunctivitis sicca (KCS) and
lens with a flatter base curve or a unique edge design.[41] The in evaluating lesions related to the herpes simplex virus
mechanical force of the margin of an ill-fitting lens causes a (HSV) and neoplastic lesions.[42] Differential diagnosis for
depression of the conjunctiva, which manifests by the pooling KCS is of specific importance because patients with Sjögren’s
of fluorescein or LG within the indentation. A patient is syndrome, tested objectively by the presence of xerostomia

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 Dhaliwal, et al.: Stains and dyes in Ophthalmology

and KCS, have a 9-fold higher prevalence of autoimmune embedded foreign body
thyroid disease.[43] • Epithelial basement membrane dystrophy (EBMD): EBMD
can be seen in about 2–6% of the patients. It can be seen
FLUORESCEIN as elevated dots, maps and fingerprints and shows up as
• Xanthene fluorophore with a weak acidic hydroxyxanthene negative staining. Tear film break-up time is reduced, in both
• Small size EBMD and dry eye syndrome. The elevations of the ocular
• C20H12O5 surface associated with EBMD result in immediate tear film
• Molecular weight 332.31 Da break-up over the corresponding area; whereas in dry eye
• The vital dye in water has a very high fluorescence syndrome, a delayed tear film break-up is seen. Patients are
with an absorption maximum at 490 nm at pH 9 and asymptomatic unless the dots, maps and fingerprints erupt,
excitation at 494 nm and emission maximum of 521 nm stain positively and become symptomatic
• Fluorescein may be conjugated with over 50 different • Herpetic keratitis: Dendritic ulcers with edges slightly
elevated due to swollen epithelial cells are associated
salts or derivatives, including fluorescein sodium and
with the HSV.
fluorescein diacetate
• The xanthene compound has been shown to stain the
vitreous gel, either in the form of fluorescein sodium or Seidel’s test
fluorescein diacetate, in ocular surgery.[44,45] A moistened fluorescein strip impregnated with concentrated
Fluorescein is used widely as a diagnostic tool, in evaluation fluorescein dye is applied directly over the suspected site of
of the ocular surface and fluorescein angiography. The most perforation/bleb in operated cases of trabeculectomy and the
important purpose of fluorescein sodium staining in cornea site is observed through the slit lamp. If there is a perforation
is to detect epithelial defects and to assist in the diagnosis of and a leak exists, the dye gets diluted by the aqueous and
corneal abrasion, erosions and keratitis as it stains damaged appears as a green (dilute) stream within the dark orange
cells only at the ocular surface.[16] pool (concentrated) of the dye. The stream of aqueous is best
detected with the blue light of the slit lamp.[1]
SOME MORE COMMON CORNEAL STAINING Fluorescein dye is also used in Jones dye disappearance test
PATTERNS INCLUDE for the assessment of functional patency of the lacrimal
• Superficial punctate keratitis (SPK): SPK presents as passage.[1]
diffuse/isolated dots across the cornea. Poor contact lens Fluorescein is also injected into the lacrimal apparatus
fit or infection can cause an isolated pattern, whereas with a syringe for the identification of canalicular ends in
diffuse patterns may be seen in solution toxicity or an traumatic laceration of the lid margins and repair of the
interaction between certain lens/solution combinations canaliculi.[1]
or dry eye syndrome
• Superior epithelial arcuate lesion: It presents parallel to ROSE BENGAL
the superior limbus and is due to mechanical chaffing by
• Acidic hydroxyxanthene of large overall size
a contact lens on the superior cornea. In this condition,
• C20H2Cl4I4Na2O5
the patient is usually asymptomatic
• Molecular weight 1017.64 Da
• Inferior arcuate staining: Inferior arcuate staining is seen
• Absorption maximum of 548 nm in aqueous alkali and
parallel to the inferior limbus and is due to dehydrated
when excited in the green emits at 567 nm
contact lenses associated with insufficient post-lens tear
• Ever since its first reported use on the eye in 1914 in
film and the patient may present with mild discomfort
ophthalmology, RB is used in various ocular surface
• Three and 9 o’clock staining: 3 and 9 o’clock staining
disorders.[46]
presents parallel to the nasal and temporal limbus,
occurs due to dry eye associated with contact lenses and RB is a derivative of fluorescein. It is being used for the
patients may experience mild discomfort assessment of a number of other ocular pathologies including
• Dimple veil staining: This is not exactly staining, but meibomian gland dysfunction, herpetic corneal epithelial
just pooling of the dye into corneal indentations caused dendrites, SPKs and dysplastic or squamous metaplastic
by air bubbles trapped under a poorly fitting rigid gas cells of conjunctival squamous neoplasms. RB is additionally
permeable contact lens. The presentation is as sharply shown to have intrinsic cellular toxicity.
demarcated, circular patterns of stain on the cornea
• Foreign body staining: A foreign body or mechanical TRIAMCINOLONE ACETONIDE
trauma stain can present in various forms, such as a Triamcinolone acetonide is a white-coloured steroid,
zigzag-shaped abrasion or as the outline shape of an commonly used as a staining agent for identifying the

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 Dhaliwal, et al.: Stains and dyes in Ophthalmology

vitreous.[26] Its crystals bind to the vitreous gel, enabling 6. Mencucci R, Pellegrini-Giampietro DE, Paladini I, Favuzza E,
visualisation of a clear contrast between empty portions of Menchini U, Scartabelli T. Azithromycin: Assessment of
the vitreous cavity and areas, in which vitreous fibres are still intrinsic cytotoxic effects on corneal epithelial cell cultures.
present. Clin Ophthalmol 2013;7:965-71.
7. Januschowski K, Mueller S, Spitzer MS, Schramm C,
Triamcinolone acetonide is introduced in the vitreous Doycheva D, Bartz-Schmidt KU, et al. Evaluating retinal
cavity in the area that has to be checked at a concentration toxicity of a new heavy intraocular dye, using a model of
of 4% (0.1–0.3 ml, 40 mg/ml). This steroid is injected during perfused and isolated retinal cultures of bovine and human
vitrectomy for the management of retinal detachment, to origin. Graefes Arch Clin Exp Ophthalmol 2012;250:1013-22.
prevent fibrin reaction and proliferative vitreoretinopathy 8. Januschowski K, Mueller S, Spitzer MS, Lueke M, Bartz-
postoperatively. It improves identification of tissue through Schmidt KU, Szurman P. The effects of the intraocular dye
brilliant blue G (BBG) mixed with varying concentrations of
the deposition of crystals, helping the surgeon achieve
glucose on retinal function in an isolated perfused vertebrate
complete detachment and removal of the posterior hyaloid
retina. Graefes Arch Clin Exp Ophthalmol 2011;249:483-9.
and improving the results of primary vitrectomy for the 9. Lüke M, Januschowski K, Beutel J, Lüke C, Grisanti S, Peters S,
management of retinal detachment and diabetic retinopathy et al. Electrophysiological effects of brilliant Blue G in the
in young patients.[47] model of the isolated perfused vertebrate retina. Graefes Arch
Clin Exp Ophthalmol 2008;246:817-22.
CONCLUSION 10. Lüke C, Lüke M, Sickel W, Schneider T. Effects of patent blue
on human retinal function. Graefes Arch Clin Exp Ophthalmol
The use of vital stains, particularly fluorescein and lissamine
2006;244:1188-90.
green, is a must in your practice. Fluorescein is to be used to
11. Lüke C, Lüke M, Dietlein TS, Hueber A, Jordan J,
stain the cornea and lissamine green to stain the conjunctiva, Sickel W, et al. Retinal tolerance to dyes. Br J Ophthalmol
even in the asymptomatic patients. Some circumstances may 2005;89:1188-91.
warrant the use of RB, but lissamine green might be a better 12. Ehrlich P. About the methylene blue reaction of the living
option. Various patterns of staining that may occur with nerve substance. Dtsch Med Wochenschr 1886;12:49-52.
common ocular surface disruptions should be familiarised 13. Wise RJ. Pflüger. For nutrition of the cornea. Klin monthly
and used to determine the aetiology and managed Ophthalmology. 1882;20:69-81.
appropriately. 14. Sjögren H, Kenntnis Z. The keratoconjunctivitis sicca [keratitis
filiformis in hypofunction of the tear glands]. Acta Ophthalmol
Suppl 1933;13:40-5.
Declaration of patient consent
15. Norn MS. Lissamine green. Vital staining of cornea and
Patient’s consent not required as there are no patients in this conjunctiva. Acta Ophthalmol (Copenh) 1973;51:483-91.
study. 16. Kim J. The use of vital dyes in corneal disease. Curr Opin
Ophthalmol 2000;11:241-7.
17. Jones DH. Bell’s phenomenon should not be regarded as
Financial support and sponsorship pathognomonic sign. BMJ 2001;323:935 .
Nil. 18. Snyder C, Paugh JR. Rose Bengal dye concentration and
volume delivered via dye-impregnated paper strips. Optom Vis
Sci 1998;75:339-41.
Conflicts of interest 19. Vaugh DG Jr. The contamination of fluorescein solutions;
with special reference to Pseudomonas aeruginosa (bacillus
There are no conflicts of interest.
pyocyaneus). Am J Ophthalmol 1955;39:55-61.
20. Korb DR, Herman JP, Blackie CA, Scaffidi RC, Greiner JV,
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