Method of use:
- Explain the procedure to the patient
- Ask the patient to look up
- Moisten the strip with a small amount of normal saline or anesthetic drops, without touching the dye impregnated end of the strip with dropper
- Gently touch the inside of the lower eyelid with the moistened strip without touching cornea
- Allow fluorescein dye to diffuse approximately 30 seconds
How do you administer fluorescein?
Administration. Inject the dose rapidly (1 mL per second is normally recommended) intravenously into the antecubital vein, after taking precautions to avoid extravasation. A syringe, filled with FLUORESCITE, may be attached to transparent tubing and a 23 gauge butterfly needle for injection.
How do you perform a fluorescein test?
A piece of blotting paper containing the dye is touched to the surface of your eye. You are asked to blink. Blinking spreads the dye and coats the tear film covering the surface of the cornea. The tear film contains water, oil, and mucus to protect and lubricate the eye.
What are some of the uses of fluorescein?
Fluorescein is a diagnostic contrast agent particularly used in various ophthalmic procedures, such as checking for any corneal or vessel abnormalities. The application of fluorescein also extends to bioimaging whole anatomic structures and even further to cellular components in immunohistological staining.
How do you use fluorescein lamps?
Fluorescein is applied using a paper strip applicator that is wet with saline and is gently placed over the inferior cul-de-sac of the eye. Once the patient blinks, the dye is spread over the cornea. Fluorescein stains basement membrane that has been exposed by damage to the corneal epithelium.
How does fluorescein work in the eye?
Fluorescein dye is injected into a vein in the arm/hand. As dye passes through the blood vessels of your eye, photographs are taken to record the blood flow in your retina. The photographs can reveal abnormal blood vessels or damage to the lining underneath the retina. The images will be captured in black and white.
What is fluorescein used to diagnose?
A fluorescein angiogram looks at the blood vessels and the lining at the back of your eye (the retina). This test can pick up changes in the condition of your eyes. It can help the specialist make a diagnosis or tell them how well treatment is working.
Why do they put yellow dye in your eyes?
The “yellow stuff” is called sodium fluorescein and is used to evaluate the cornea. I often use sodium fluorescein during an eye exam, most commonly to check for dry eyes or corneal abrasions.
Which is the most common side effect complication of fluorescein dye?
The most common reactions associated with the fluorescein dye are nausea, vomiting, or hives. 3 Some people may also experience dry mouth, a metallic taste in the mouth, increased salivation (saliva overproduction), sneezing, or an increased heart rate.
Can you drink fluorescein?
A 20% Fluorescein sodium solution dosage is calculated and the patient is provided a straw to consume the drink as fast as is comfortable for them, with special care taken to ensure the drink is not swirled within the mouth resulting in temporary tooth staining.
How do you test for corneal abrasion with fluorescein?
0:000:45Instilling Fluorescein Dye in the Eye - YouTubeYouTubeStart of suggested clipEnd of suggested clipTo highlight defects in the corneal epithelium instill fluorescein dye into the I lightly wet a dyeMoreTo highlight defects in the corneal epithelium instill fluorescein dye into the I lightly wet a dye strip draw down the lower lid and dab the tip onto the conjunctiva of the lower lid.
How long does fluorescein stay in your system?
Your skin may have a yellowish discoloration for about 6 to 12 hours after your test. Your urine may appear bright yellow for up to 36 hours after your test.
What Colour is fluorescein?
dark orange/redFluorescein is an organic compound and dye. It is available as a dark orange/red powder slightly soluble in water and alcohol. It is widely used as a fluorescent tracer for many applications.
How do you apply fluorescein stain?
0:000:45Instilling Fluorescein Dye in the Eye - YouTubeYouTubeStart of suggested clipEnd of suggested clipTo highlight defects in the corneal epithelium instill fluorescein dye into the I lightly wet a dyeMoreTo highlight defects in the corneal epithelium instill fluorescein dye into the I lightly wet a dye strip draw down the lower lid and dab the tip onto the conjunctiva of the lower lid.
How do you check for corneal abrasion?
Corneal abrasions are also diagnosed using a special dye and light, especially in emergency departments or health care offices without access to slit-lamp biomicroscopes. After drops of fluorescein dye are inserted in the eye, the doctor shines a blue light on the eye. Any abrasions on the eye will appear green.
How do you assess corneal abrasion?
On exam, corneal abrasions can be associated with redness, light sensitivity, excessive lacrimation, decreased visual acuity. Fluorescein staining is the most helpful clinical tool to assess corneal abrasion. The dye will get caught in the corneal abrasion and fluoresce under cobalt blue light.
What dye is used in fluorescein angiography?
fluorescein sodium dyeFluorescein angiography is performed by injecting fluorescein sodium dye as a bolus into a peripheral vein.
Uses
In cellular biology, the isothiocyanate derivative of fluorescein is often used to label and track cells in fluorescence microscopy applications (for example, flow cytometry ).
Safety
Oral and intravenous use of fluorescein can cause adverse reactions, including nausea, vomiting, hives, acute hypotension, anaphylaxis and related anaphylactoid reaction, causing cardiac arrest and sudden death due to anaphylactic shock.
Chemistry
The fluorescence of this molecule is very intense; peak excitation occurs at 494 nm and peak emission at 521 nm.
Synthesis
Fluorescein was first synthesized by Adolf von Baeyer in 1871. It can be prepared from phthalic anhydride and resorcinol in the presence of zinc chloride via the Friedel-Crafts reaction .
Do not use a fluorescein strip on every patient with an eye problem
In an emergency setting, fluorescein is only useful for 2 things: Diagnosing corneal pathology and wound leaks (open globes or leaking surgical wounds). Corneal abrasions and ulcers will be painful the vast majority of the time. That’s why they come to the ED.
2. look at the patient
This may sound silly, but you can tell a lot about the surface of a patients eye (conjunctiva, cornea) by taking a pen light and comparing one eye to the other. Look at the healthy eye first. You should be able to see iris detail, its color and reactivity. You can see the shape of the pupil. In other words, it should be crystal clear.
3. Use a topical anesthetic prior to fluorescein
Lots of people come in with eye pain. A great way to determine if this pain is due to a cornea problem is administering proparacaine. Pain from a corneal abrasion or dry eye will magically melt away with anesthetic. At this point, you have 2 options:
4. Use a fluorescein solution
One option is fluorescein/topical anesthetic combination. It’s numbing and staining all at once! What a deal! It’s also a little more expensive than strips (~50 bucks for a 5ml bottle) and some of them are also on back order. Flucaine (fluorescein + proparacaine) also seems to be on back order or at least very difficult to acquire.
the good news
The great fluorescein shortage of 2018 may be coming to an end. Several manufacturers estimate that fluorescein will be back in production by the 1st or 2nd quarter of 2019, although they may just be stringing us along. In the meantime, hoard your sticks and use them judiciously.
Normal Results
If your eye is healthy and your cornea is undamaged, the dye will appear smooth across the entire surface of your eye.
Abnormal Results
Corneal abrasions or foreign particles will cause abnormal results. These may be a result of:
DESCRIPTION
Fluorescent dye; diagnostic aid; used topically to visualize the anterior surface of the eye and systemically in fluorescein angiography to examine the retinal and choroidal circulation; significant anaphylactoid reactions possible with IV use.
HOW SUPPLIED
AK-Fluor/Fluorescein/Fluorescein Sodium/Fluorescite Intravenous Inj Sol: 10%, 25% Fluorescein/Fluorescein Sodium/Ful-Glo Ophthalmic Strip: 0.6mg, 1mg Fluor-I-Strip A.T. Ophthalmic Insert: 1mg
DOSAGE & INDICATIONS
For radiographic examination (i.e., diagnostic angiography or angioscopy) of the retina and iris vasculature.
DOSING CONSIDERATIONS
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that dosage adjustments are not needed.
ADMINISTRATION
Administer by intravenous injection. An intradermal skin test may be performed prior to intravenous administration.
STORAGE
AK-Fluor: - Do not freeze - Store at controlled room temperature (between 68 and 77 degrees F) Fluorescite: - Do not freeze - Store at controlled room temperature (between 68 and 77 degrees F) Fluor-I-Strip: - Store at 77 degrees F Fluor-I-Strip A.T.: - Store at 77 degrees F Ful-Glo: - Storage information not listed
DRUG INTERACTIONS
Angiotensin-converting enzyme inhibitors: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Overview
Fluorescein is an organic compound and dye. It is available as a dark orange/red powder slightly soluble in water and alcohol. It is widely used as a fluorescent tracer for many applications.
The color of its aqueous solutions is green by reflection and orange by transmission, as can be noticed in bubble levels, for example, in which fluorescein is added as a colorant to the alcohol filling the tube in order to increase the visibility of the air bubble contained within (thus enhancing the …
Uses
Fluorescein sodium, the sodium salt of fluorescein, is used extensively as a diagnostic tool in the field of ophthalmology and optometry, where topical fluorescein is used in the diagnosis of corneal abrasions, corneal ulcers and herpetic corneal infections. It is also used in rigid gas permeable contact lens fitting to evaluate the tear layer under the lens. It is available as sterile single-use sachets containing lint-free paper applicators soaked in fluorescein sodium solution.
Safety
Oral and intravenous use of fluorescein can cause adverse reactions, including nausea, vomiting, hives, acute hypotension, anaphylaxis and related anaphylactoid reaction, causing cardiac arrest and sudden death due to anaphylactic shock.
Intravenous use has the most reported adverse reactions, including sudden death, but this may reflect greater use rather than greater risk. Both oral and topical uses have been reported to cau…
Chemistry
The fluorescence of this molecule is very intense; peak excitation occurs at 495 nm and peak emission at 520 nm. Values for the deprotonated form in basic solution.
Fluorescein has a pKa of 6.4, and its ionization equilibrium leads to pH-dependent absorption and emission over the range of 5 to 9. Also, the fluorescence lifetimes of the protonated and deprotonated forms of fluorescein are approximately 3 and 4 ns, which allows for pH determinat…
Derivatives
Many derivatives of fluorescein are known. Example
• fluorescein isothiocyanate 1, often abbreviated as FITC, features an isothiocyanate group (−N=C=S) substituent. FITC reacts with the amine groups of many biologically relevant compounds including intracellular proteins to form a thiourea linkage.
• succinimidyl ester modified fluorescein, i.e. NHS-fluorescein, is another common amine-reactive derivative, yielding amide adducts that …
Synthesis
Approximately 250 tons/y were produced in the year 2000. The method involves the fusion of phthalic anhydride and resorcinol, similar to the route described by Adolf von Baeyer in 1871. In some cases, acids such as zinc chloride and methanesulfonic acid are employed to accelerate the Friedel-Crafts reaction.
Research
Fluorescein is a fluorophore commonly used in microscopy, in a type of dye laser as the gain medium, in forensics and serology to detect latent blood stains, and in dye tracing. Fluorescein has an absorption maximum at 494 nm and emission maximum of 512 nm (in water). The major derivatives are fluorescein isothiocyanate (FITC) and, in oligonucleotide synthesis, 6-FAM phosphoramidite.
See also
• Chemical derivatives of fluorescein:
• Fluorescein diacetate hydrolysis, a biochemistry laboratory test
• Other dyes: