Fluorescein and Rose Bengal Staining

Fluorescein and Rose Bengal Staining

Fig. 1.4 (a) Survey. In the green stained tear film are visible individual or grouped brilliantly green dots (straight arrows) and surface elevations (dark; bowed arrow) (17 days after symptom onset; Ad8). (b) Survey. Rose bengal stains damaged surface cells/ cell debris red. The area in frame is shown at higher magnification in (c). (c–e) Only damaged superficial cells stain red; the rounded/abnormal cells (arrowheads) do not stain. (11 days after symptom onset; Ad8)

Comment

In this patient, some rose bengal staining in the in-between areas was possibly relatable to a (probably preexisting) dry eye; because of its stinging property, the dye was used only in a few patients.

81 The Morphology of Adenovirus Epithelial Keratitis

Epithelial Infiltrates 1

c

Fig. 1.5 (a) Survey. With fluorescein are visible several larger light-reflecting lesions/infiltrates (long arrows), green dots (short arrow), and surface elevations (bowed arrow). The area in frame is shown at higher magnification in b. (b) The infiltrates (arrows) show green fluorescein stained dots visible between damaged surface cells/cell debris staining red with rose bengal; there is no fluorescein diffusion into the surroundings. (The long arrows in a and b are placed in corresponding locations.) (c) Many rounded/ abnormal cells (arrowheads) are present in the in-between areas; the arrow points to an additional infiltrate. (12 days after symptom onset; Ad8)

Epithelial Infiltrates 2

Fig. 1.6 (a–f) Various aspects of epithelial infiltrates (arrows): (a) light-reflecting property, (b) granular appearance, (c, d) circumscript fluorescein staining and surface elevations (dark, bowed arrows), (e) absence of fluorescein diffusion, and (e, f) rose bengal staining of damaged surface cells/cell debris ((f) is a composed photograph). (12 days after symptom onset; Ad8. The markers are placed in corresponding locations)

10 1 The Morphology of Adenovirus Epithelial Keratitis

Addendum 1. Toxic E ect of Rose Bengal Dye

a

b

Fig. 1.7 (a) In this cornea, before staining, the surface epithelium seemed normal and with fluorescein showed only a few green dots; after the application of rose bengal myriads of variously shaped green dots appeared (arrow). (b) shows a different area of the same cornea; to the left is visible green fluorescein staining (arrow), to the right a minimal rose bengal staining (black arrowhead), and in the center a group of rounded/abnormal cells (white arrowhead). (6 weeks after symptom onset; Ad8)

Comment

Th is phenomenon is a manifestation of the toxic effect of rose bengal. The dye seems to cause disruptions of inter-

cellular junctions, and the (transparent) superficial cells are indirectly visualized by penetration of green stained tear fluid below them.