An assessment of the discomfort associated with the use of rose bengal 1% eyedrops on the normal human eye: a comparison with saline 0.9% and a topical ocular anaesthetic

Purpose: To assess the time-dependent changes in ocular comfort following unilateral instillation of preservative-free rose bengal 1% eyedrops when compared with saline 0.9% or proxymetacaine 0.5%. Methods: A total of 61 subjects, aged between 19 and 77 years, were asked to complete an ocular symptoms questionnaire, and then to indicate the comfort level for each eye on a 100-point visual analogue scale (VAS). A single drop of rose bengal was instilled in one eye (left or right) and a drop of saline or anaesthetic instilled in the other eye. The VAS assessments were repeated at an average of 4 and 7 min later. Results: The instillation of rose bengal eyedrops produced an initial average reduction in comfort of 39.8 points, as compared with a reduction of 11.5 points following the anaesthetic and a reduction of 3.4 points for saline. However, the responses to rose bengal were highly variable, ranging from reductions of 1.5 to 84.6 points. In most subjects, some recovery had occurred within 6-8 min, but the comfort scores averaged 27.8 points below baseline levels prior to rose bengal. Slightly greater discomfort was noted by older subjects and those with darker irides. Conclusions: This study confirms that the use of rose bengal eyedrops can elicit a sensation of discomfort, but that this adverse reaction does not last very long. Based on the initial kinetics of recovery from discomfort, it is estimated that this should last no longer than 10-15 min (at least for those without significant ocular surface disease).