Lissamine green staining of the bulbar conjunctiva in keratoconjunctivitis sicca

Lissamine green staining of the bulbar conjunctiva in Sjögren's-related dry eye disease.
(A) Lissamine green background staining of the bulbar conjunctiva. Some pooling of dye is present, but <10 discrete individual green dots are seen in the interpalpebral area. These findings would equate to a score of 0 with the Sjögren's International Collaborative Clinical Alliance (SICCA) ocular stain scoring system^[1].
(B) Lissamine green staining of the bulbar conjunctiva showing discrete individual green dots, numbering >10 and <33, in the interpalpebral area. These findings equate to a SICCA ocular staining score of 1. Staining on the surface of the adjacent pingueculum is considered an artifact and is therefore ignored.
(C) Discrete individual green dots, numbering 33 to 100, are seen in the interpalpebral area equating to a SICCA ocular staining score of 2. The two areas of partial confluent staining are each <4 mm² and are therefore scored as 33 to 100 dots.
(D) More than 100 individual green dots are present in the interpalpebral area and are associated with many areas of confluent staining.