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Corneal Staining or Fluorecein Eye Stain

Test that uses orange dye (fluorescein) and a blue light to detect foreign bodies in the eye. Can also detect damage to the cornea, to the outer surface of the eye.

Why the test is performed? It is useful in identifying superficial scratches or other problems with the surface of the cornea Also help reveal foreign bodies on the eye surface Can be use after the contacts are prescribed to determine if there is irritation of the surfaceof the cornea.

TYPES: Micro punctate Macropunctate Calescent macropunctate Patch

HOW THE TEST IS PERFORMED? piece of blotting paper containing the dye will be touched to the surface of the eye client will be ask to blink. Blinking spreads the dye around and coats the tear film covering the surface of the cornea a blue light is then directed at your eye. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light

The health care provider can determine the location and likely cause of the cornea problem depending on the size, and shape of the staining. RISKS: if the staining (fluorescein) touches the skin surface, there may be a slight, brief discoloration.

HOW TO PREPARE FOR THE TEST: remove your contact lenses before the test

HOW THE TEST WILL FEEL: if the eyes are extremely dry, the blotting paper may be slightly scratchy. The dye may cause a mild and brief stinging sensation.

NORMAL RESULTS: if the test result is normal, the dye remains in the tear film on the surface of the eye and does not adhere to the eye itself.

WHAT ABNORMAL RESULTS MEAN?: abnormal tear production = (dry eye) corneal abrasion = (a scratch on the surface o the cornea) foreign bodies, such as eyelashes etc. infection injury or trauma severe dry eye associated with arthritis (keratoconjunctivitis sicca)

NURSING RESPONSIBILITIES: identify the patient to ensure that correct patient will receive the treatment if the patients wearing any contact lenses instruct him to remove it explain that the procedure is painless wash hands and instill topical anesthesia to both eye to reduce discomfort instruct the patient not to rub eyes 45 minutes after the procedure

Additional Information: Corneal staining is a process that is generally useful in detecting the damage to the different corneal cells. In this process, a diagnostic dye is generally instilled on the corneal surface and this is generally useful in diagnosing a condition that is generally found to occur in those who are prone to damage owing to the contact lenses. The staining that results from the mechanical chaffing of the lens on the cornea is of particular interest. This type of staining is generally considered as the precursor to corneal tissue splitting. This type of damage has been generally observed in people who wear lathe cut lenses. These lenses are generally made from the materials which are having a Youngs modulus of 40 psi or greater. Corneal cell damage has also found to be associated with people wearing the lenses that have certain geometries on their front or back surfaces. In most cases, the geometries that have been found to be more problematic are those in which the junctions between the zones on the front or the back surface of the lens leads to discontinuities of the surface generally in the mid-peripheral area of the lens. It is most common to find the corneal tissue staining due to mechanical chaffing in the superior region of the cornea or in that area of the cornea which is above the pupil and is in the inferior region. Thus, it may be said that the cell damage can be more commonly be found in the areas of the cornea which either underlie upper or the lower eyelid.

Corneal staining with a topical dye is a clinical procedure used to observe the integrity and vitality of the epithelial cells of the corneal surface. The most commonly used vital dye or

indicator dye is sodium fluorescein and others include Rose Bengal and lissamine green. Fluorescein dye is released from commercially available sterile paper strips by wetting the strips with saline and then touching to the conjunctiva. When applied to the ocular surface, the dye discolors the tear film to an orange color and the cobalt blue light of a slit lamp causes the fluorescein dye to take on a bright greenish-yellow appearance. The observation of subtle details of the corneal and conjunctival surface may be greatly enhanced by viewing the ocular surface through a photographicgrade yellow barrier filter because the filter isolates the wavelength of fluorescence, while blocking out other wavelengths. The fluorescein will penetrate damaged cell membranes or pool in gaps in the corneal surface when surface cells are disrupted or displaced. Any abrasions or compromises in the integrity of corneal epithelial cells are highlighted by a brighter glow of fluorescein than the uniform background fluorescence of the dyed tear film, hence the term corneal staining. In extreme cases when the epithelial layer of the cornea has a full thickness compromise, fluorescein easily passes from the tear film into the corneal stroma, leading to a green fluorescent glow within the cornea.