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
- Remove the back plunger from a 3 mL syringe
- Insert the fluorescein strip into the back of the syringe
- Replace the plunger
- Aspirate about 1 ml of normal saline into syringe
- Remove the needle
Voila! You now have a syringe of fluorescein eye drops.
- Prepare this outside the room. If the patient sees the large gauge needle you use to draw up the saline, they often freak out.
- 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.