Comparative performance of lissamine green stains

Area of Science:

• Ophthalmology
• Dry Eye Disease Research
• Ocular Surface Diagnostics

Background:

• Lissamine green staining is a common method for evaluating ocular surface health.
• Understanding variations in lissamine green strip performance is crucial for accurate diagnosis.
• Lid wiper epitheliopathy is an important indicator of dry eye disease.

Purpose of the Study:

• To compare the performance of lissamine green strips from different manufacturers.
• To assess the repeatability of lissamine green staining.
• To evaluate the impact of lid eversion techniques on staining results.

Main Methods:

• Prospective, randomized cross-over and controlled studies were conducted.
• Lissamine green solutions from four manufacturers were tested.
• Lid wiper staining was graded by masked observers after single/double instillation and single/repeated lid eversion.

Main Results:

• Significant differences in lid wiper staining were observed between lissamine green solutions (e.g., GreenGlo highest, Lissaver lowest).
• Repeated lid eversion significantly increased lid wiper staining (p=0.007).
• Sequential dye instillation and the Korb grading scale showed limited advantage over simpler methods.

Conclusions:

• Lissamine green strip performance varies significantly by manufacturer.
• Repeated lid eversion is a critical factor influencing lid wiper staining results.
• Clinicians should carefully consider these factors when interpreting lid wiper staining, especially in negative findings.