Visualisation of ‘Marx's line’ along the marginal eyelid conjunctiva of human subjects with lissamine green dye

Abstract

Purpose: To qualitatively assess the frequency and intensity of the staining of Marx's line with lissamine green dye. Methods: Eighty‐five non‐contact lens wearers, aged 18–78 years and of white (European) or Arabic origin, were assessed. The subjects had no major eye disease, although some had mild‐to‐moderate congestion of the main tarsal (Meibomian) glands and/or anterior blepharitis. Lissamine green dye strips were used to stain the marginal zone of the palpebral conjunctiva, and then high magnification photo slitlamp images were taken. Results: A lissamine green staining line was unmistakable in 83 of the subjects, and just evident in the other two. The line extends along the entire length of the upper and lower lid margins, and the staining broadens and extends over the puncta. In most subjects, the lissamine green‐stained line was posterior to the main tarsal gland orifices, but in five subjects it was distinctly anterior to the orifices. In over two‐thirds of the subjects, the width of line was much less than the distance between the gland orifices, and was at a similar distance to its width from the orifices. However, in one‐third of the subjects, the width of the line was around half that of the distance between the orifices or slightly greater (i.e. approximately 0.5 mm), and this feature was more commonly present in those of non‐European origin. Conclusion: Lissamine green dye highlights a very distinct line of cells along the marginal zone, and should be a useful tool to visualise this feature. This line of cells is thought to be the natural site of contact between the eyelid margin and the surfaces of the bulbar conjunctiva and cornea.