Ocular surface staining: Current concepts and techniques

Indian J Ophthalmol. 2023 Apr;71(4):1080-1089. doi: 10.4103/ijo.IJO_2137_22.


The health of the ocular surface is vital for clear vision and comfort. Various factors can adversely influence the ocular surface and tear film homeostasis, and these include procedures like cataract and corneal refractive surgery. It is, therefore, important to assess the integrity of the ocular surface in a rapid, predictable, and consistent manner in the clinic. Various tests and devices have been described, and while these are useful, this article highlights the importance of using fluorescein staining of the ocular surface in detecting changes. This is a simple, inexpensive, rapidly performed test that is available in most eye clinics. However, a proper technique of dye instillation and assessment is important to recognize the changes that can occur. Once detected, these changes can be quantified, and the location and patterns can be used to diagnose the diseases that are present; these changes can also be used to monitor treatment outcomes and disease progression. The article discusses the technique, assessment, and interpretation of fluorescein staining of the ocular surface, along with the role of the two other vital dyes - rose bengal and lissamine green.

Keywords: Dry eye disease; fluorescein; interpretation; ocular surface staining; vital dyes.

Publication types

  • Review

MeSH terms

  • Cornea
  • Dry Eye Syndromes* / diagnosis
  • Fluorescein
  • Humans
  • Lissamine Green Dyes
  • Staining and Labeling
  • Tears


  • Lissamine Green Dyes
  • Fluorescein