Which three ocular surface staining techniques are described?

• A. Fluorescein; Rose Bengal; Lissamine Green
• B. Fluorescein; Rose Bengal; Schirmer tear test
• C. Rose Bengal; Lissamine Green; Tetracaine
• D. Fluorescein; Lissamine Green; Rose Bengal

Answer: (A)

Staining the ocular surface uses dyes to reveal where the corneal and conjunctival epithelium is damaged or where mucus and dead cells are present, helping us map surface health. Fluorescein is the workhorse for corneal epithelial defects; when viewed with cobalt blue light, areas of corneal irregularity take up the dye and appear as bright regions, clearly outlining ulcers or abrasion. Rose Bengal targets devitalized cells and areas with irregular mucin coverage on the ocular surface, staining those compromised spots to highlight surface compromise. Lissamine Green behaves similarly to Rose Bengal, staining dead or degenerated cells and mucus, but it tends to be gentler on the conjunctiva and is comfortable for the patient while still revealing surface abnormalities. Together, these three dyes form the classic trio used to describe ocular surface staining patterns and health.

The other options mix in a non-staining test or an agent, which isn’t used to visualize the surface in this way. The Schirmer tear test measures tear production, not staining, and tetracaine is an anesthetic, not a dye.