Rose Bengal Staining

Rose bengal is a vital dye used to demonstrate ocular-surface epithelial cells that are inadequately protected by the normal mucin-tear film. It may highlight corneal and conjunctival surface disease in dry eye and related disorders.

How to do the test

  1. Instil a small amount of rose bengal into the lower conjunctival sac.
  2. Ask the patient to blink several times to distribute the dye.
  3. Select the appropriate ocular-surface photography mode in OSDx.
  4. Focus the cornea and exposed bulbar conjunctiva with the patient looking straight ahead.
  5. Acquire the image promptly while the staining pattern is clearly visible.
  6. Additional gaze positions may be used when wider conjunctival documentation is required.
Rose bengal can sting and may itself cause ocular-surface irritation. Use the smallest practical amount and avoid repeated instillation unless clinically necessary.

Clinical relevance

Rose bengal may reveal ocular-surface damage associated with aqueous-deficient dry eye, keratoconjunctivitis sicca and other disorders affecting the protective mucin layer.

Interpretation

Assess the location, density and pattern of staining rather than relying on a single isolated area. The result should be considered together with symptoms, fluorescein staining, tear-film stability and lid and meibomian-gland findings.

Lissamine green is often preferred for routine use because it is generally better tolerated, but rose bengal remains a useful ocular-surface stain in selected clinical settings.