The Use of 1% Toluidine Blue Eye Drops in the Diagnosis of Ocular Surface Squamous Neoplasia

The Use of 1% Toluidine Blue Eye Drops in the Diagnosis of Ocular Surface Squamous Neoplasia

Author Romero, Ivana L. Autor UNIFESP Google Scholar
Barros, Jeison de Nadai Autor UNIFESP Google Scholar
Martins, Maria C. Autor UNIFESP Google Scholar
Ballalai, Priscilla Luppi Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Purpose: To evaluate the use of in vivo toluidine blue (TB) dye in the diagnosis of ocular surface squamous neoplasia and to correlate staining intensity with the histopathological diagnosis.Methods: A prospective study was performed at the Federal University of São Paulo, Brazil. Patients with conjunctival epithelial lesions were examined by slit-lamp biomicroscopy, with and without 1% TB eye drops, and the results were photodocumented. Before the instillation of the dye, 1% proxymetacaine HCl eye drops were used. All patients were submitted to surgery and histopathological analysis to confirm the diagnosis. the patients were grouped according to the histopathological aspects of the lesions into 3 groups: group 1-patients with ocular surface squamous neoplasia; group 2-patients with premalignant lesions; and group 3-patients with pterygium. the digital images were analyzed by 2 masked examiners who had no previous access to the histopathological results. the photographs were classified according to the positivity and intensity of the staining. the statistical analysis method chosen depended on the type of data, with the level of significance set as P < 0.05.Results: Forty-seven patients were included in the study: 10 had benign lesions (pterygium), 10 had premalignant lesions (actinic keratosis), and 27 had malignant lesions (conjunctival intraepithelial neoplasia and conjunctival squamous cell carcinoma). Agreement between observers regarding the analysis of the digital photographs was 100% for positivity and 82.9% for intensity of staining (kappa = 0.938). Ninety percent of patients with premalignant lesions and all patients with malignant lesions showed positive staining with 1% TB. One patient had positive staining, but histopathological examination revealed a benign lesion (false positive).Conclusions: the use of 1% TB eye drops is an efficient method for the clinical diagnosis of ocular surface squamous neoplasia and premalignant lesions. Nevertheless, the intensity of the staining does not correlate with the degree of malignancy of these tumors.
Keywords toluidine blue
conjunctival neoplasm
squamous cell carcinoma
Language English
Date 2013-01-01
Published in Cornea. Philadelphia: Lippincott Williams & Wilkins, v. 32, n. 1, p. 36-39, 2013.
ISSN 0277-3740 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 36-39
Access rights Closed access
Type Article
Web of Science ID WOS:000312007500008

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