On the staining of human tissue-cultured (Chang) conjunctival cells with rose bengal and lissamine green

Lid wiper epitheliopathy

Some recent research has resulted in a hypothesis that there is a common 'lid wiper' region that is apposite to the ocular surface or anterior lens surface (where contact lenses are worn), responsible for spreading tears during blinking. In the upper eyelid, it extends about 0.6 mm from the crest of the sharp posterior (inner) lid border (i.e. the mucocutaneous junction, or line of Marx) to the subtarsal fold superiorly and from the medial upper punctum to the lateral canthus horizontally. Histologically, it is seen as an epithelial elevation comprising of stratified epithelium with a transitional conjunctival structure of (moving posteriorly) squamous cells then cuboidal cells, with some parakeratinised cells and goblet cells. Lid wiper epitheliopathy (LWE) denotes staining of the lid wiper observed after instillation of dyes such as fluorescein, rose bengal or lissamine green. There have been some reports of higher rates of LWE in dry eye patients and contact lens wearers, but others have failed to find such associations. The primary cause of LWE is thought to be increased friction between the lid wiper and ocular or anterior contact lens surface due to inadequate lubrication, which could be caused by dry eye and may be exacerbated by factors such as abnormal blinking patterns, poor contact lens surface lubricity and adverse environmental influences. Recent evidence suggests that LWE is associated with sub-clinical inflammation. LWE has the potential to provide the missing mechanistic link between clinical observation and symptoms associated with dry eye and contact lens wear. Clinical and fundamental research into LWE is still in its infancy and in many instances equivocal; however, it is an idea that provides a potentially important new avenue for further investigation of anterior eye discomfort associated with ocular dryness and contact lens wear.

Fluorescence characteristics of sodium fluorescein-rose bengal ophthalmic solution mixtures

PURPOSE

To assess fluorescence emission properties of sodium fluorescein-rose bengal mixtures in buffered aqueous solution.

METHODS

Solutions of sodium fluorescein (NaFl) or rose bengal (RB) or mixtures of these two chemicals were prepared over a range of dilutions in 1% NaCl with 10mM phosphate buffer to give a pH of 7.5 at room temperature. Absorbance and fluorescence spectra were recorded in 10mm path length cuvettes.

RESULTS

The fluorescence emission from NaFl extends between 480 and nearly 600nm, a spectral range that is also covered by the absorbance of RB (between 500 and 580nm). With very dilute solutions of NaFl (less than 0.002%), an apparent total quenching of its fluorescence can occur in the presence of 0.01% RB, with a proportionate decrease at lower concentrations of RB.

CONCLUSIONS

The presence of RB in an aqueous solution of NaFl at physiological pH appears to act in a similar way to a barrier filter, resulting in the quenching of the measurable fluorescence from NaFl. It remains to be established how substantial or significant such an effect might be if a mixture of NaFl and RB as used as part of the examination of the external eye.