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Abstract

Backgrounds/Objectives: The aim of this study was to compare differences in the physical characteristics of lissamine green (LG) strips and the outcomes of using different staining techniques. Methods: Two separate complementary investigations were conducted. Physical study: Differences between four LG strips were evaluated in terms of material, dye concentration, and dye absorption. In vivo study: Bulbar conjunctival staining was compared for four application methods of I-DEW LG strips presented in a randomized order for twenty-two participants: (1) single application 5 s after wetting (also repeated using GreenGlo for comparison), (2) single application using two strips held together, 5 s after wetting, (3) two applications using a single LG strip 5 s after wetting, 1 minute apart, (4) the same as method 3, with a single fluorescein strip in between LG applications. White light imaging was performed immediately following application and after 30, 60, 90, and 300 s. Three masked practitioners independently evaluated the randomized staining images for spot count and staining intensity. Results: Physical study: Strip paper fibres demonstrated visible similarities, with no difference in saline absorption (p > 0.05). LG concentration increased as saline retention duration increased (F = 964.1, p < 0.001), and GreenGlo tips were significantly darker (F = 2775.2, p < 0.001). In vivo study: I-DEW application resulted in less conjunctival staining than GreenGlo (p < 0.001). Amongst I-DEW application techniques, staining levels were similar (p > 0.05); however, staining intensity was significantly higher following two applications of I-DEW, 1 min apart, compared to a single application (p = 0.042). Both spot count and staining intensity decreased with time (p < 0.001). Conclusions: Two applications of I-DEW using a single strip, 1 min apart, after wetting with a single drop of saline provided maximal staining. There was also a significant difference in staining intensity observed between LG products.

Publication Date

2025-03-17

Publication Title

Journal of Clinical Medicine

Volume

14

Issue

6

Acceptance Date

2025-03-07

Deposit Date

2026-04-22

Funding

This project was organized, funded, and run by members of the British and Irish University and College Contact Lens Educators (BUCCLE). For the period of this study, sponsorship was received from Alcon, Bauch + Lomb, CooperVision Johnson & Johnson Vision Care, No7, and Menicon. No specific grant was received for this study, and none of the sponsors had any input or involvement within this project.

Keywords

bulbar conjunctiva, lissamine green, ophthalmic dye, physical characteristics, staining, technique

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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