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Vital Dye — Ocular Surface Staining (Dry Eye Diagnosis) Pregnancy: Safe for single diagnostic use — negligible systemic absorption; no contraindication in pregnancy

Lissamine Green 1% Eye Drops

Brand names: Lissamine Green Ophthalmic Solution

Adult dose

Dose: 1–2 drops of 1% lissamine green solution or single impregnated strip moistened with saline
Route: Topical ophthalmic (instilled into lower fornix)
Frequency: Single diagnostic instillation per assessment
Max: N/A — diagnostic use only
Green dye that stains devitalised and mucin-deficient epithelial cells; examine within 1–4 minutes of instillation; staining pattern assessed by slit-lamp; van Bijsterveld score or Oxford grading used; less toxic and less irritating than rose bengal (the traditional alternative)

Paediatric dose

Route: Topical
Frequency: Single diagnostic use
Max: As adult
Diagnostic use in paediatric dry eye and VKC assessment — well tolerated

Dose adjustments

Renal

N/A — diagnostic agent, single use

Hepatic

N/A

Clinical pearls

  • Preferred over rose bengal: lissamine green stains devitalised epithelial cells and mucin-deficient cells with equal or superior sensitivity to rose bengal — but with significantly less ocular irritation; rose bengal causes significant stinging that itself can trigger reflex tearing, confounding dry eye assessment; lissamine green is now the preferred dye in most dry eye clinics
  • Van Bijsterveld score: standard scoring system for vital dye staining — nasal conjunctiva, cornea, temporal conjunctiva each scored 0–3 (0=no staining, 3=confluent staining); maximum score 9; score ≥3.5 (rose bengal) or equivalent lissamine green pattern indicates significant ocular surface disease
  • TFOS DEWS II diagnostic criteria (2017): vital dye staining (lissamine green for conjunctiva, fluorescein for cornea) is one of the core diagnostic signs for dry eye disease — combined with OSDI questionnaire, TBUT, Schirmer test, and lipid layer assessment; lissamine green specifically recommended for conjunctival staining
  • Mechanism of staining: lissamine green penetrates cells where tight junctions are disrupted or mucin glycocalyx is absent — indicates surface cell death or dysfunction; unlike fluorescein (which stains through gaps between cells or erosions), lissamine green identifies damaged cells while they remain on the surface
  • Staining strips (impregnated): single-use lissamine green strips are the most hygienic method — moisten tip with sterile saline, touch lower fornix gently; avoids contamination associated with multi-dose drops and provides consistent dye concentration; used in clinical trials for standardisation

Contraindications

  • Known allergy to lissamine green or food dye components
  • Do not use if contact lenses in situ

Side effects

  • Mild transient stinging or burning
  • Temporary green discolouration of tears and conjunctiva (self-resolving in minutes)
  • Rarely — conjunctival irritation

Interactions

  • None clinically significant — single diagnostic use

Monitoring

  • No ongoing monitoring required — single diagnostic use
  • Staining pattern documented photographically for follow-up comparison
  • Retest at 3–6 months to assess treatment response

Reference: BNFc; BNF 90; TFOS DEWS II Diagnostic Methodology Report (Ocul Surf 2017); van Bijsterveld OP, Arch Ophthalmol 1969; SPC Lissamine Green Ophthalmic; NICE TA369. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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