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Types of Dye Used in Eye Examinations: Fluorescein, Rose Bengal, Lissamine Green

  • 5 min read

There are several types of color dyes that doctors use during an eye examination, each with a unique purpose:

  • Fluorescein Dye: This is perhaps the most common dye used in eye examinations. It’s a yellow-orange dye that, when placed in the eye, illuminates under a special blue light. Fluorescein can highlight scratches, sores, foreign bodies, or other damage on the surface of the eye, specifically the cornea. This dye is used in a fluorescein angiography, which allows the ophthalmologist to examine the retina’s blood vessels.

Fluorescein is a synthetic organic compound that is available as a dark orange/red powder slightly soluble in water and alcohol. It is widely used in diagnostics, especially in ophthalmology, where it is used to illuminate structures in the eye under a special blue light to detect foreign bodies, corneal abrasions, and other eye injuries.

In a process known as fluorescein staining, the dye is topically applied to the eye. It does not cause discomfort or pain when administered. Once in the eye, fluorescein adheres to areas where cells may be damaged or missing, making them visible under a specific type of light often emitted by a slit-lamp biomicroscope.

When the eye is exposed to blue light, areas that have absorbed the fluorescein dye will glow with a greenish-yellow fluorescence, allowing the ophthalmologist or optometrist to see any damage or abnormalities clearly. The dye can highlight tiny scratches, foreign objects, or infections on the surface of the eye.

Another important use of fluorescein dye is in a procedure known as fluorescein angiography. In this diagnostic test, the dye is injected into a vein in the arm rather than applied topically. It travels to the blood vessels in the eye, making them visible under blue light. This test allows doctors to examine the retina in detail, to diagnose conditions like macular degeneration, diabetic retinopathy, and retinal detachment, among others.

As with any medical procedure, the use of fluorescein dye carries some risks, though these are generally low. Potential side effects can include nausea, vomiting, and an allergic reaction in rare cases. The skin and urine may also become discolored (usually a yellowish color) for a short period after the test.

Despite these potential side effects, fluorescein is considered generally safe for use in diagnostic procedures involving the eye due to its low toxicity and the valuable information it can provide about the health of the eye.

  • Rose Bengal Dye: This is another important dye used in eye exams. It’s used to identify damage to the eye’s surface, particularly in cases of dry eye or other similar conditions. Rose Bengal dye has a unique characteristic of sticking to dead or dying cells, making it easier for the doctor to identify problem areas.
  • Lissamine Green Dye: This dye is often used in dry eye examinations and is comparable to Rose Bengal dye. It is a less irritating option and is becoming more popular for identifying problems with the eye’s surface. Like Rose Bengal, it highlights dead or dying cells on the eye’s surface.

Lissamine green is a dye used in ophthalmology to detect changes or damage to the surface of the eye. It’s most frequently used in diagnosing conditions such as dry eye syndrome and Sjogren’s syndrome, but it can be useful in a variety of other settings as well.

Lissamine green has a particular affinity for dead or degenerated cells, especially cells of the mucous membranes, and it also stains areas where the protective film over the eye (the tear film) is not covering the surface adequately. This makes it excellent for diagnosing problems with the surface of the eye, the conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids), and the cornea.

The staining procedure is fairly simple. A small strip of paper impregnated with the dye is moistened and then touched to the surface of the eye. The patient is then asked to blink to spread the dye across the eye’s surface. An ophthalmologist or optometrist will examine the eyes under a slit-lamp microscope, which will reveal any areas of damage or irregularity.

Unlike rose bengal, another common eye surface dye, lissamine green is not generally irritating to the eye, which makes it a preferred choice for many eye care professionals. However, it can cause temporary discoloration of contact lenses.

The use of lissamine green can provide valuable information about the health of the eye’s surface, and it’s a crucial tool in diagnosing and managing eye surface disorders. As always, it should be administered under the care of a healthcare professional who can interpret the results accurately and advise on next steps.

  • Indocyanine Green (ICG) Dye: ICG dye is used in eye exams to help doctors visualize the blood vessels in the retina and choroid (the vascular layer of the eye situated between the retina and the sclera). This is especially helpful in identifying conditions such as age-related macular degeneration or choroidal neovascular membranes.

These dyes are typically safe for use in the eye, but if you’re scheduled for an examination that requires one, make sure to inform your doctor of any allergies or health conditions you may have. It’s also a good idea to ask about the potential side effects of these dyes.

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