Usefulness of Double Vital Staining With 1% Fluorescein and 1% Lissamine Green in Patients With Dry Eye Syndrome

Purpose: To determine the relative staining characteristics of the nasal and temporal conjunctiva as compared with other measures of dry eye and evaluate the qualitative clinical impression of the utility of the double vital staining with fluorescein and lissamine green. Methods: Ocular surface staining was performed with a mixture of 1% fluorescein and 1% lissamine green in 50 patients with dry eye ( 12 patients with Sjogren syndrome and 38 patients with non-Sjogren syndrome). Ocular surface disease index ( OSDI), tear breakup time ( BUT), and Schirmer test were evaluated. Digital photographs were taken after vital staining on the ocular surface, and the grade of staining in various areas was assessed. Correlation among the degrees of staining, OSDI, and ocular surface parameters was analyzed. Results: The nasal conjunctiva evidenced greater staining compared with the temporal conjunctiva and cornea ( P = 0.04). Staining of the nasal conjunctiva showed significant correlation with OSDI ( P < 0.01) and BUT ( P = 0.03). Staining of the temporal conjunctiva correlated significantly with OSDI ( P = 0.01), and staining of the cornea correlated with BUT ( P = 0.02). Conclusions: Double vital staining with 1% fluorescein and 1% lissamine green correlates with symptoms and some ocular surface parameters in patients with dry eye and helps to identify ocular surface changes easily. It may be a useful method for the diagnosis of dry eye and the assessment of the therapeutic effect in patients with dry eye syndrome.