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Ocular Pharmacology > Diagnostic Stains > Flashcards

Diagnostic Stains Flashcards

1
Q

what type of light do diagnostic stains emit?

A

lower energy (longer wavelength) - molecule will absorb highest energy (shortest wavelength)

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2
Q

are diagnostic stains acidic or basic?

A

can be either but not neutral

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3
Q

Is fluorescein water or oil soluble? and where is it ionized?

A

water soluble and ionized in the tears (hydrophilic)

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4
Q

When will fluorescein be able to enter the cornea (lipophilic)?

A

cornea will be compromised (not intact) - dry eye, abrasion, ulcer, lesions - tight junctions are broken = corneal staining

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5
Q

what is absorption of fluorescein for tissue and blood?

A

excited by 493nm (cobalt blue) and 465nm in bloodstream

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6
Q

why does the blood need a higher energy to become excited?

A

binding in the blood to albumin and RBC’s reduces the activity

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7
Q

what is the emission of fluorescein?

A

520nm (yellow/green color is seen)

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8
Q

what color of fluorescein is seen on the tear film?

A

orange/yellow/green –> need to enhance with a wratten filter

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9
Q

what is seidel’s sign?

A

used to assess the presence of anterior chamber leakage through the cornea from a penetrating injury (will see fluorescent green in bowman’s membrane or aqueous humor)

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10
Q

what is quenching?

A

some atoms or molecules can facilitate non-radiative transitions to ground state (occurs without emitting photo - steals the energy)

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11
Q

which anesthetic causes the least amount of quenching? what about the most?

A 
least = BAK + benoxinate
middle = proparacine
most = tetracaine
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12
Q

what happens to IOP readings with fluorescein quenching?

A

intensity is diminished - underestimation of IOP

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13
Q

how can fluorescein detect an ulcer?

A

penetration below basement membrane of corneal epithelium - exposes the stroma = dye will disperse 360 in eye

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14
Q

how can fluorescein detect an alkaline burn?

A

chemicals/molecules will precipitate by biding with a salt and deposit in the lower fornix - will stain will dye

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15
Q

how can fluorescein evaluate tear break-up time (TBUT)?

A

after complete blink - look for the first randomly distributed dark spot in tear film (interval = TBUT)

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16
Q

how can fluorescein be used to evaluate RGP CL adaptation?

A

anywhere you see dye it is trapped under the lens - not in absolute contact with the eye (need different lens if no dye is seen)

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17
Q

how do you use a Wratten filter when elvauating RGP fit?

A

filter is required over the light source

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18
Q

how can fluorescein be used to diagnose a tear duct obstruction/epiphora?

A

use with a Jones test

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19
Q

how is fluorescein used with aniline dye from indelible pencils?

A

it is an antidote - methyl violet spreads through ocular tissues and is precipitated by 2% sodium fluorescein

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20
Q

how can you measure aqueous humor production with fluorescein?

A

patient drinks dye –> goes into bloodstream and to the eye (watch appearance in anterior chamber)

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21
Q

how can fluorescein be used to distinguish between viral keratitis caused by herpes simplex or herpes zoster?

A

dye highlights the filaments
simplex = bulb-like ends
zoster = thin ends

22
Q

How is fluorescein used in angiography?

A

used to visualize structural defects, vascular pathology, tumors, RPE thinning, CME, AMD (10-15 sec to arrive at retina)

23
Q

After administering fluorescein to antecubital vein, what do you watch for on the fundus photos?

A

any areas of pooling in the macula = diabetes, AMD, Stargardt’s disease and tumors

24
Q

What are HMW (high molecular weight) fluorescein formulations used for?

A

used with soft CL because they can stain with LMW - the HMW are too large to be absorbed by the lens

25
Q

What are some examples of topical fluorescein formulations?

A

Fluoracaine + proparacine, Fluress + benoxinate, and Flu-Glo (strips)

26
Q

What are some examples of HMW fluorescein formulation?

A

Fluoresoft PF and Fluora-safe + benoxinate and SoftGlo

27
Q

What allergies should you avoid giving fluorescein to?

A

ester anesthetics - PABA

28
Q

What are some common adverse reactions to topical fluorescein?

A

string, irritation, redness, dermatitis, nausea and headaches

29
Q

What pregnancy category is fluorescein?

A

C

30
Q

What are some serious adverse reactions to topical fluorescein?

A

corneal hypersensitivity, epithelial keratopathy, seizures, CNS depression, anaphylaxis

31
Q

What is the absorption for Rose Bengal?

A

545-490nm

32
Q

What does Rose Bengal stain?

A

mucus or devitalized tissue

33
Q

What color do degenerated/dead cells stain with Rose Bengal?

A

mildly degenerated cells = light red
severely degenerated cells = dark red
dead cells = intense red

34
Q

What filter do you use to view Rose Bengal?

A

viewed under white light or red-free (green filter) –> blocks red light - only allowing green through

35
Q

Why is it necessary to collect cultures before using rose bengal or lissamine green?

A

they have mild anti-viral properties

36
Q

What is the purpose of using Rose Bengal?

A

to detect if there is reduced tear volume through detection of damaged epithelial cells

37
Q

How can rose bengal be used to detect HSVK?

A

RB stains the damaged epithelial cells on the border of an HSVK ulcer

38
Q

What are some conditions rose bengal is used for in detection?

A

keratoconjunctivitis sicca (KCS), superior limbic keratoconjunctivities (SLK), herpes zoster/simplex

39
Q

What are the adverse side effects of rose bengal?

A

irritating to eye (use with anesthetic) and may have hypersensitivity (iodine-based)

40
Q

What does lissamine green stain?

A

mucus or devitalized tissue

41
Q

How is lissamine green better than rose bengal in staining?

A

better contrast in red, inflamed or hemorrhagic eyes and is longer lasting without irritation

42
Q

What is the absorption for lissamine green?

A

567-634nm

43
Q

What filters is lissamine green viewed under?

A

white light or red filter (green-free) - blocks out green light and only allows red (green appears black)

44
Q

When is lissamine green used?

A

KCS (dry eyes), superior limbic KC, herpes simplex/zoster

45
Q

What are some adverse effects of lissamine green?

A

minimal irritation (less than RB), itch, hypersensitivity (rare)

46
Q

What is fluramene?

A

Fluorescein and lissamine green together

47
Q

When is fluramene used?

A

for corneal and conjunctival staining simultaneously (devitalized tissue, mucus, corneal surface irregularities)

48
Q

What is indocyanine green?

A

used in ophthalmology as an IV stain

49
Q

What is the absorption for indocyanine green?

A

790nm

50
Q

How is indocyanine green different from fluorescein?

A

it doesn’t leak from the choriocapillaries, RPE doesn’t block its emission spectrum, and it is the best dye for CNVM (AMD)

Ocular Pharmacology (10 decks)

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