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DIAGNOSTIC STAINS Flashcards

1
Q

What are properties of Diagnostic Stains?

A

1) To enhance contrast
2) Special affinity for ocular tissues and cells
3) Acidic or basic
4) Chromatic differentiation depends on distinct absorption and emission spectrum

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2
Q

What are characteristics of Fluorescein?

A 
Water soluable (Weak Dibasic xanthine acid)
Ionized in tears 
orange-yellow-green in tear film
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3
Q

What is the absorption level in FLUORESCEIN?

A

AT 493 NM FOR cobalt blue

465 nm in Blood

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4
Q

What is the Emission rate in FLUORESCEIN?

A

AT 520 NM (YELLOW GREEN)

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5
Q

what is Seidel’s sign?

A

Fluorescent green in bowman’s membrane or aqueous humor
Due to Precipitation of the cornea
aquous humor leakage out of anterior chamber because there is a penetrating abrasion

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6
Q

Why is hepatic metabolism important with FLUO?

A

because, if you are giving orally, and the pt has liver disease, you are recognizing they are not going to metabolize to metabolize without any difficulty

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7
Q

what is QUENCHING?

A

this is when the FLUORESCEIN intensity goes down giving you false negative findings may result

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8
Q

Can Anesthetics can be quenching? If so, what is the order of the drugs from Least to Most?

A

Yes

least) BAC and Benoxinate < Proparacaine < Tetracaine (most quenching

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9
Q

What are the indications of the FLUORESCEIN?

A

Foreign body
Abrasion or ulcer and Edema
Alkaline burn: non soluble particles
Dry eye staining and tear breakup time (TBUT)

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10
Q

What confirms the Foreign body?

A

Siedel’s sign confirms full thickness corneal penetration

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11
Q

What should be done always at first when evaluating abrasion or ulcer and edema?

A

Locate of anterior chamber for cells and flare always should be completed before staining

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12
Q

What does alkaline burn do?

A

Pt with Fluorescein dye will highlight the alkaline particles that are less soluble, you have remove all the particles, of the injury

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13
Q

What happens with the TBUT

A

with the FLUO dye, the normal healthy eye will make a nice uniform layer, if its normal it will be 10 seconds or more for TBUT, if its sooner, explain dryness

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14
Q

What is PUNCTATE KERATITIS?

A

inflammation on the corea, and its superficial that cuases small patches of keratitis

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15
Q

Penetrating the stroma causes?

A

ULCER

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16
Q

FLUORESCEIN examination done in what type of lamp?

A

COBALT BLUE

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17
Q

How to evaluate the RGP CL ?

A

Staining under lens is blue in absence of stain

Green edges means there is edge lift, which may begood

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18
Q

In ORTHO k - what is the objective in RGP?

A

to create 5 microns over corneal apex

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19
Q

How much thicker the layers need to be in a human eye to detect fluorescein?

A

20 microns or thicker

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20
Q

What kind of filter do you need to evaluate RGP?

A

Wratten 47, since RGPS may block UV from burton lamp

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21
Q

What is Epiphora? and what test do you use to evaluate this?

A

Epiphora = tears running down the cheek, due to obstruction of the naso lacrimal duct

Jones test

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22
Q

What is Jones 1?

A

2% Fluorescein to ocular surface, blow through one side nostil (ipsilateral) after 5 mintues, if dye appears on the tissue the dye passed thorugh nasal lacrimal duct, if not then use JONES II

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23
Q

What is Jones II?

A

To confirm the location of obstruction of the canal

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24
Q

What is Aniline Tint Antidote?

A

methyl violet = which is a aniline dye that is used to permanent pencils spreads through ocular tissues and percipitated out by 2% sodium fluorescein

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25
How much do you use to measure aqueous humar production?
0. 5% oral fluorescein - we are using the oral form, this will appear ant chamber and give info about ciliary body - - impt GLAUCOMA
26
What is Filamentous Keratitis?
Inflammation of the cornea, that forms mucous type of epithelial filament that form fiber there fore FLUO abosrs this very well you can use to identify the keratitis
27
How to recognize HSV KERATITIS?
it will have bulbar like endings or round endings | uses sodium FLUOrescien to recognize
28
SIMPLEX ZOSTER?
when they dont have bulbar like endings, | Uses sodium fluorescein to recognize
29
what is applation tonometry?
it is a way to estimate the IOP PRESSURE
30
why Fluorescein not good with tonometry?
becaue it underestimate it, therefore we need to use a ANESTHETIC , since the probe does touch the surface of the cornea
31
what is the applanation zone?
3.06 mm diameter
32
What is used to visualize structura defects, vascular pathology and tumoros?
ANGIOGRAPHY | - it takes about 10-15 minutes sec to arrive to the central retinal artery
33
whats the rate of aqueous production?
2% per min | ex. entrie anterior chamber volume is recycled every 50 mints
34
what is the rate for the angiography given?
5ml for 10% 3 ml for 25% IV 0.5% for PO
35
what is Stargardt's disease?
Genetically inherited juvenile macular degeneration often developing 6-12 eyears manifest in visual photo-transduction cycle
36
Which dyes are good to use applenation tonometry?
Fluoracaine | Fluress
37
FLUORACAINE contains?
0.25% with 0.5% proparacaine
38
FLURESS contains?
0.25% with 0.4% benoxinate | It also has 1% chlorobutanol preservative which provides good anti HSV-1 but not EKC AV 19 and 8
39
Which one is a preservative free type of Fluorescein?
FUL-GLO that contains 0.6mg sterile strips
40
What should be avoided when using sodium fluoroscein? (what reacts more with FLUO)
High molecular weight, more than or equal to 60% water content contact lens should be avoided ex. B&L softlens, ciba dailies/ FOCUS PURE VISION, BM line and cooper are resistant ** Higher the water content the more it will dissolve FLUORESCEIN.
41
what is the refrigerated shelf time for FLUORESCEIN?
1 MONTH
42
which one stains more? when using this dye?
Peroxide based solutions, will react with HMW and FLUORESCEIN and cause stain the lenses
43
Which type would you give orally?
Fluorescite 10% un-preserved
44
Which type considered nontoxic?
FLUORESCEIN strips - FLU GLO
45
Which ones area anesthetic?
FLURA-SAFE ---which is high molecular weight and its safe FLURESS --liquid form
46
Which one is safer for CL?
FLUORESOFT-0.35% | non preservative
47
what are the common adverse reactions of TOPICAL FLUORESCEIN?
Sting Irritation Redness Dermatitis
48
What are the SEVERE adverse reactions?
Corneal hypersensitivity Epithelial keratopathy, corneal Seizures CNS Depression
49
What are the Adverse reactions from IV FLUORESCEIN?
Nausea and Vomiting will occur within 30 seconds and last up to 1 minute Headache Tissue necrosis Cutaneous Reaction
50
What are the RARER FLUORESCEIN IV reaciton?
``` Allergy Cardiac failure Vagal Rxn. Convulsions Shock ```
51
Pt should avoid FLUORESCEIN when?
They have hypersensitivity to ester anesthetics, PABA ACHE deficiency, cardiac or thyroid disease ( anesthetic reactions)
52
What is ROSE BENGAL is best for?
Vividly stains mucus strands and filaments so is ideal for identification of reason for dry eye - - goblet cells due to lack of mucus - - Also stains devitalized/dead tissue - - It has Mild antiviral properties
53
Does it EMITT wavelength?
NO | IT ABSORBS around 545-490 nm
54
Do you need to use a filter to use it?
No, use white light in the slit or RED FREE FILTER which can also means GREEN FILTER
55
Degenerated tissue looks like under ROSE BENGAL?
Light bluish red
56
Severely degenrated?
Dark red
57
Dead cells look like?
Intense RED
58
Whats the relationship with ROSE BENGAL and Hemolysis?
By exciting the molecule with certain frequency the RBC cells will break, causing it to destroy the cells. this is another way to treat cancer
59
The difference between FLUORESCEIN AND ROSE BENGAL ?
is the use of Iodine based derivative in ROSE BENGAL | --- PPL who have allergies for iodine and shelfish should not use this
60
Rose Bengal indications TOPICAL?
Kerato-conjunctivits Sicca (KCS) Superior Limbic kerato-conjunctivits (SLK) Herpes Simplex / Zoster = this dye outlines the virus
61
Rose bengal IV indications?
Argon laser photocoagulation | Metastatic Melanoma
62
What are Rose Bengal Adverse Effects?
Prounounced irritant
63
What are rare effects of rose bengal?
Hypersensitivity
64
What are characteristics of Lissamine Green?
``` Stains mucous or deviated tissue Absorption at 567-634 nm Conjunctival and corneal application Viewed undre white light or red filter Atriviral properiteis ```
65
What is Lissamine Green formulated with?
Pretreated sterile strips 1.5mg
66
LIssamine Green used to Dx what diseaes?
KCS - dry eye Superior Limbic KC Herpes simplex/ zoster
67
what are the SECONDARY SIDE EFFECTS from rose bengal?
Minimal irritation itch Hypersensitvity (rare)
68
What are charcteristics of FLURAMENE?
Combination of Lissamine gree and Dluorescein
69
What are the side effects of this?
Same as lissamine green and fluoresxcein effects
70
FLURAMENE made with?
15ml solution
71
FLURAMENE used to Dx?
Simltaneous corneal and conjunctivial staining
72
what are characterstics of Indocyanine Green?
Water soluable Peak absortpion 790 nm Hepatic clearance; t1/2 2-3 min
73
What are the formulations of INDOCYANINE GREEN?
Powder solute for IV USE
74
what is INDOCYANINE GREEN used to dx?
Cardio vascular, hepatic angiography Iris/retinal/chorodial angiography, CNVM ILM Capsulorrhexis
75
What are the side effects of INDOCYANINE GREEN?
Nausea and Vomiting sneezing anaphylaxis (rare)
76
What are contradictions for indocyanine green?
Iodine or shelfish allergy Uremia or hepatology Pregnancy or lactation

OCULAR PHARM (4 decks)

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