What are the limitations to Rose Bengal staining?

• A. Ocular irritation and cytotoxic effects
• B. It stains tear film but not cornea
• C. It stains only healthy conjunctiva
• D. It requires fluorophotometry to interpret results

Answer: (A)

Rose Bengal staining is limited primarily by its irritant and cytotoxic effects on the ocular surface. The dye tends to sting and can damage corneal and conjunctival epithelium, especially with prolonged contact or repeated use. This irritation not only causes patient discomfort but can also confound interpretation of epithelial integrity, making it less reliable for repeated assessments or in eyes with already compromised surfaces. Additionally, Rose Bengal stains devitalized cells and areas of mucin deficiency, not just tear film, and interpretation is done with standard slit-lamp examination rather than requiring specialized tools like fluorophotometry. For these reasons, ocular irritation and potential cytotoxicity are the main limitations.