Trick of the Trade: Easy ocular application of fluoroscein

Gently instilling a fluorescein drop into a patient’s eye requires that the patient keep his/her eye still. What do you do for a patient who can’t quite stay still enough, such as an infant? This is an innovative trick of the trade, written by Dr. Sam Ko (Loma Linda EM resident) and Kimberly Chan (Loma Linda medical student).

Trick of the Trade

Create a fluoroscein eyedropper

A 14-month old male is brought into the Emergency Department by his mother because he is rubbing his eye and inconsolably crying. You suspect a corneal abrasion or foreign body and decide to quickly evaluate his cornea using the fluorescein stain. Using the method below, you’ll be able to perform the exam with little discomfort to the patient.

1. You will need a small vial of saline (left) and a fluorescein strip in packaging (right).

2. Open only one end of the fluorescein strip package.

3. Insert saline flush vial into the package.

4. Flush saline in and out of the packaging several times until the fluid in the bottle turns yellow.

5. Now that the saline vial contains fluorescein, use the container like an eye dropper.

Pearls to consider:

• Defects in the corneal epithelium will appear green under the light.
• Beware that mucus can also stain green. If you aren’t sure which is which, ask the patient to blink. The mucus will move, but the defects won’t.
• Remove contact lens before this exam, because they can become permanently stained (perhaps a cool Halloween trick for next year?).
• Pseudomonas easily grows in fluorescein dye, so never reuse or share dye.

Thanks, Sam and Kimberly. Great trick!

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