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OCULAR PHARM > DIAGNOSTIC STAINS > Flashcards

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
Q

How much do you use to measure aqueous humar production?

A
  1. 5% oral fluorescein
    - we are using the oral form, this will appear ant chamber and give info about ciliary body
    - - impt GLAUCOMA
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26
Q

What is Filamentous Keratitis?

A

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

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27
Q

How to recognize HSV KERATITIS?

A

it will have bulbar like endings or round endings

uses sodium FLUOrescien to recognize

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28
Q

SIMPLEX ZOSTER?

A

when they dont have bulbar like endings,

Uses sodium fluorescein to recognize

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29
Q

what is applation tonometry?

A

it is a way to estimate the IOP PRESSURE

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30
Q

why Fluorescein not good with tonometry?

A

becaue it underestimate it, therefore we need to use a ANESTHETIC , since the probe does touch the surface of the cornea

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31
Q

what is the applanation zone?

A

3.06 mm diameter

32
Q

What is used to visualize structura defects, vascular pathology and tumoros?

A

ANGIOGRAPHY

- it takes about 10-15 minutes sec to arrive to the central retinal artery

33
Q

whats the rate of aqueous production?

A

2% per min

ex. entrie anterior chamber volume is recycled every 50 mints

34
Q

what is the rate for the angiography given?

A

5ml for 10%
3 ml for 25% IV
0.5% for PO

35
Q

what is Stargardt’s disease?

A

Genetically inherited juvenile macular degeneration often developing 6-12 eyears

manifest in visual photo-transduction cycle

36
Q

Which dyes are good to use applenation tonometry?

A

Fluoracaine

Fluress

37
Q

FLUORACAINE contains?

A

0.25% with 0.5% proparacaine

38
Q

FLURESS contains?

A

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
Q

Which one is a preservative free type of Fluorescein?

A

FUL-GLO that contains 0.6mg sterile strips

40
Q

What should be avoided when using sodium fluoroscein? (what reacts more with FLUO)

A

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
Q

what is the refrigerated shelf time for FLUORESCEIN?

A

1 MONTH

42
Q

which one stains more? when using this dye?

A

Peroxide based solutions, will react with HMW and FLUORESCEIN and cause stain the lenses

43
Q

Which type would you give orally?

A

Fluorescite 10% un-preserved

44
Q

Which type considered nontoxic?

A

FLUORESCEIN strips - FLU GLO

45
Q

Which ones area anesthetic?

A

FLURA-SAFE
—which is high molecular weight and its safe

FLURESS
–liquid form

46
Q

Which one is safer for CL?

A

FLUORESOFT-0.35%

non preservative

47
Q

what are the common adverse reactions of TOPICAL FLUORESCEIN?

A

Sting
Irritation
Redness
Dermatitis

48
Q

What are the SEVERE adverse reactions?

A

Corneal hypersensitivity
Epithelial keratopathy, corneal
Seizures
CNS Depression

49
Q

What are the Adverse reactions from IV FLUORESCEIN?

A

Nausea and Vomiting will occur within 30 seconds and last up to 1 minute

Headache
Tissue necrosis
Cutaneous Reaction

50
Q

What are the RARER FLUORESCEIN IV reaciton?

A 
Allergy
Cardiac failure 
Vagal Rxn.
Convulsions
Shock
51
Q

Pt should avoid FLUORESCEIN when?

A

They have hypersensitivity to ester anesthetics, PABA

ACHE deficiency, cardiac or thyroid disease ( anesthetic reactions)

52
Q

What is ROSE BENGAL is best for?

A

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
Q

Does it EMITT wavelength?

A

NO

IT ABSORBS around 545-490 nm

54
Q

Do you need to use a filter to use it?

A

No, use white light in the slit or RED FREE FILTER which can also means GREEN FILTER

55
Q

Degenerated tissue looks like under ROSE BENGAL?

A

Light bluish red

56
Q

Severely degenrated?

A

Dark red

57
Q

Dead cells look like?

A

Intense RED

58
Q

Whats the relationship with ROSE BENGAL and Hemolysis?

A

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
Q

The difference between FLUORESCEIN AND ROSE BENGAL ?

A

is the use of Iodine based derivative in ROSE BENGAL

— PPL who have allergies for iodine and shelfish should not use this

60
Q

Rose Bengal indications TOPICAL?

A

Kerato-conjunctivits Sicca (KCS)
Superior Limbic kerato-conjunctivits (SLK)
Herpes Simplex / Zoster = this dye outlines the virus

61
Q

Rose bengal IV indications?

A

Argon laser photocoagulation

Metastatic Melanoma

62
Q

What are Rose Bengal Adverse Effects?

A

Prounounced irritant

63
Q

What are rare effects of rose bengal?

A

Hypersensitivity

64
Q

What are characteristics of Lissamine Green?

A 
Stains mucous or deviated tissue
Absorption at 567-634 nm
Conjunctival and corneal application
Viewed undre white light or red filter
Atriviral properiteis
65
Q

What is Lissamine Green formulated with?

A

Pretreated sterile strips 1.5mg

66
Q

LIssamine Green used to Dx what diseaes?

A

KCS - dry eye
Superior Limbic KC
Herpes simplex/ zoster

67
Q

what are the SECONDARY SIDE EFFECTS from rose bengal?

A

Minimal irritation
itch
Hypersensitvity (rare)

68
Q

What are charcteristics of FLURAMENE?

A

Combination of Lissamine gree and Dluorescein

69
Q

What are the side effects of this?

A

Same as lissamine green and fluoresxcein effects

70
Q

FLURAMENE made with?

A

15ml solution

71
Q

FLURAMENE used to Dx?

A

Simltaneous corneal and conjunctivial staining

72
Q

what are characterstics of Indocyanine Green?

A

Water soluable
Peak absortpion 790 nm
Hepatic clearance; t1/2 2-3 min

73
Q

What are the formulations of INDOCYANINE GREEN?

A

Powder solute for IV USE

74
Q

what is INDOCYANINE GREEN used to dx?

A

Cardio vascular, hepatic angiography
Iris/retinal/chorodial angiography, CNVM
ILM
Capsulorrhexis

75
Q

What are the side effects of INDOCYANINE GREEN?

A

Nausea and Vomiting
sneezing
anaphylaxis (rare)

76
Q

What are contradictions for indocyanine green?

A

Iodine or shelfish allergy
Uremia or hepatology
Pregnancy or lactation

OCULAR PHARM (4 decks)

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