Lissamine Green Staining

Lissamine green is a vital dye used to assess conjunctival and ocular-surface epithelial stress. It stains devitalised or damaged epithelial cells and areas with deficient mucin protection, and is widely used in the assessment of dry eye disease.

How to do the test

  1. Instil lissamine green into the lower conjunctival sac.
  2. Ask the patient to blink several times to distribute the dye evenly.
  3. Select the appropriate ocular-surface photography mode in OSDx.
  4. Ask the patient to look straight ahead and focus the exposed nasal and temporal bulbar conjunctiva and corneal surface.
  5. Acquire clear images before the stain becomes too dilute.
  6. If required, obtain additional images in up-gaze or down-gaze to document superior or inferior conjunctival staining.

Clinical relevance

Lissamine green is particularly useful for documenting conjunctival staining in dry eye disease, including interpalpebral staining and areas of ocular-surface epithelial stress that may be less obvious with fluorescein alone.

Because lissamine green generally causes less discomfort than rose bengal, it is commonly preferred for routine ocular-surface staining.

Interpretation

Record both the severity and distribution of staining. Nasal and temporal conjunctival staining, lid-wiper staining and focal patterns can provide clinically useful information when correlated with tear-film and lid findings.