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Trick of the Trade: Fluorescein eyedrops

2016-11-11T18:51:02+00:00

FluoresceinStrip
This is a guest post by Dr. Ian Brown (Stanford):

The Roberts textbook describes the procedure of corneal fluorescein staining as touching a moistened fluorescein strip to the cornea.  Maybe it is an irrational fear of a paper cut to the sclera, or a fear of touching an already abraded cornea with the paper, but I try to find an alternative. I have seen physicians hold the eye open with one hand, hold the fluorescein with a second hand and then drip tetracaine on the paper and let it drip into the eye with a third hand. I, unfortunately, only have two hands.

Trick of the Trade

Make your own fluorescein eyedrops

Procedure

  1. Remove the back plunger from a 3 mL syringe
  2. Insert the fluorescein strip into the back of the syringe
  3. Replace the plunger
  4. Aspirate about 1 ml of normal saline into syringe
  5. Remove the needle

Voila! You now have a syringe of fluorescein eye drops.

Tips

  1. Prepare this outside the room.  If the patient sees the large gauge needle you use to draw up the saline, they often freak out.
  2. To apply any eye drop, have the patient lean back with eyes closed.  Place 2 drops in medial canthus.  When the patient open their eyes, the drops run in.
Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

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  • Anonymous

    This takes too much time… there’s a better way to do this. Bend the end of the fluoroscein strip at about a 60 degree angle just proximal to the colored part, then hold the strip against the side of the eye dropper bottle with one hand such that the bent end of the strip is sticking out underneath the dropper, squeeze and voila, one handed fluoroscein eye drops without wasting your time

    • Excellent tip. Yes this does seem faster. Personally, I haven’t had problems with people shying away from the fluoroscein strips. I put a drop of proparacaine on the colored part of the strip. I have the patient look up as far as they can and pull down their lower eyelid. (They can’t see me coming!) I barely touch the beaded drop of proparacaine, to the inferior fornix of the conjunctiva. When they blink a few times, the solution goes everyone.

  • Agree. Takes too long, and I don’t find patients hating the strips.

    I’d like to see if there was a way to mix fluroscein and tetracaine or proparacaine and save the solution. I always thought that would be a hand combo eye drop to have.

    • I thought of the same combo idea. I’m guessing that it would be prone to contamination/degradation if left to sit around for > 24 hours.

    • Anonymous

      They make a product that is a combination of proparacaine and fluoroscein, it’s called flucaine or fluorocaine

  • I do something similar. use the respiratory therapy saline bullet, squeeze a drop of saline on the fluroscein, then hold the container upright, squeeze the air out, then suck it back in. repeat. now the saline bullet is a fluroscein mix!

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