To determine the diagnostic usefulness of routine staining of corneal buttons with alcian blue, we evaluated 150 consecutive corneal specimens with hematoxylin and eosin and alcian blue stains. Overall, 67% of specimens demonstrated deposition of acid mucopolysaccharide. More specifically, positive alcian blue staining was observed in 88% of specimens with pannus, 83% of specimens with stromal downgrowth, 71% of specimens with stromal scarring, and 67% of specimens with interstitial keratitis. In 80% of these cases, the positive alcian blue stain correlated to pathology noted on hematoxylin and eosin sections. In 20% of cases, we could not explain the reason for the presence of alcian blue staining. Except for macular dystrophy of the cornea, the presence, strength, and location of staining did not provide useful information in terms of making a specific clinical diagnosis. Consequently, alcian blue should be used only in those settings in which the pathologist needs to document or confirm the abnormal presence or absence of acid mucopolysaccharide deposition.
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