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 Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD