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Cornea: Rose Bengal dye test

pequis

Synonym(s): Rose Bengal ophthalmic stain


Introduction

  • Rose Bengal (dichlorotetraiodofluorescein) is an ophthalmic stain used in the diagnosis of ocular surface pathology. Although it belongs to the group termed 'vital stains' it stains the nuclei (and to a lesser extent other organelles) of dead or degenerated epithalial cells, as well as healthy epithelial cells which lack mucin coverage.
  • Staining patterns are dose and possibly time dependent.
  • Historically Rose Bengal stain was available in the form of a single use vial of 1% solution (Minims Rose Bengal) but this has been discontinued in the UK; it may still be available in other countries. Impregnated paper strips are the form currently available to clinicians in the UK.
  • Slit lamp biomicroscopy may be required for full evaluation of staining patterns.

Uses

  • Detection of devitalized corneal or conjunctival epithelial cells in cases of suspected viral or fungal infection.
  • Detection of areas of cornea with poor mucin coverage indicative of a qualitative tear film deficiency.
  • Rose Bengal positive microerosions may be a manifestation of equine keratomycosis.
  • Rose Bengal staining has anecdotally been used to demonstrate the degree and extent of tissue damage in squamous cell carcinomas of the conjunctival surfaces in horses. The prior application of ophthalmic phenylephrine (2.5% phenylephrine hydrochloride, Minims) blanches the conjunctiva, making staining patterns of the conjunctiva more vivid.

Advantages

  • Inexpensive.
  • Rapid.
  • Provides additional information to that of fluorescein staining.

Disadvantages

  • Noted to cause discomfort in human patients, although appears to be well tolerated in companion animal species.

Requirements

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Procedure

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Khan-Lim D & Berry M (2004) Still confused about Rose Bengal? Curr Eye Res 29 (4-5), 331-317 PubMed.
  • Brooks D E et al (2000) Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis. Vet Ophthal (2-3), 83-86 PubMed.
  • Feenstra R P & Tseng S C (1992) Comparison of fluorescein and Rose Bengal staining. Ophthalmol 99 (4), 605-617 PubMed.
  • Feenstra R P & Tseng S C (1992) What's actually stained by rose bengal? Arch Ophthalmol 110 (7), 984-993 PubMed

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