Fluorescein (Ophthalmic Stain)
Fluorescein sodium
Brand names:Fluorets, Ful-Glo, Fluress (fluorescein + benoxinate combination)
A water-soluble fluorochrome dye used to visualize corneal epithelial defects and identify globe perforation under cobalt blue or Wood lamp light. Fluorescein staining is the single most useful diagnostic adjunct for ocular surface injury in tactical and emergency settings. Combined with topical anesthetic, it converts a painful, photophobic, blepharospasming eye into one that can be reliably examined in minutes.
Pharmacology and Actions
Fluorescein is a water-soluble fluorochrome dye. It does not penetrate intact corneal epithelium but is absorbed into damaged epithelium and corneal stroma. Under cobalt blue or ultraviolet light, fluorescein fluoresces green-yellow, highlighting epithelial defects. Dye pools in the tear film over intact epithelium and washes away with blinking. Seidel sign: aqueous fluid leaking through a globe perforation dilutes the dye, producing a visible dark stream within the fluorescein-stained tear film.
Indications
- Detection of corneal abrasion or epithelial defect
- Identification of foreign body track on cornea
- Identification of Seidel sign (aqueous leak through globe perforation)
- Assessment of tear film and contact lens fit
- Diagnosis of dry eye and herpes simplex dendritic keratitis pattern
Absolute Contraindications
- Known hypersensitivity to fluorescein
- Soft contact lenses in place (permanently stains the lens)
Precautions and Side Effects
Topical: minor stinging on instillation, transient yellow tear staining and occasional yellow staining of skin if dye runs from eye. Stains soft contact lenses (must be removed before application). Allergic reaction to fluorescein is rare with topical use. No clinically significant interactions for topical use. Pregnancy: topical ophthalmic use considered safe. Compatible with lactation. Safe at any pediatric age. Contact lens wearers: remove soft lenses before application; can reinsert after 30 to 60 minutes once dye washes out.
Adult Dosing
Pediatric Dosing
Same technique as adult. Strips are well tolerated in cooperative children.
Pharmacokinetics
Peak Effect: Immediate fluorescence on contact with corneal epithelial defect under cobalt blue light.
Duration: Tear film washout within minutes; corneal staining persists at sites of epithelial defect until healing occurs.
Storage and Handling
Strips: store at room temperature, protect from light, keep packaging sealed. Solution bottles (if used): single-use containers preferred; multi-use bottles must be discarded if any contamination is suspected. Shelf life typically 2 to 3 years for strips.
Reconstitution:
Strips are dry; wet with sterile saline (one drop) just before use. Do not use tap water. Do not pre-wet strips and store.
TCCC and TECC Role
Fluorescein staining is not in the TCCC core formulary. It appears in tactical EMS supplemental formularies as the diagnostic adjunct for ocular trauma evaluation. Used alongside topical anesthetic (proparacaine or tetracaine) to enable evaluation. Mission impact is none - fluorescein itself has no operational consequence.
Fluorescein staining is the single most useful diagnostic test for ocular surface injury in the tactical setting. Combined with topical anesthetic, it converts a painful, photophobic, blepharospasming eye into one that can be reliably examined in minutes. The cobalt blue light on a basic ophthalmoscope or a dedicated Wood lamp is sufficient. Indications you will see in the field: dust or debris in the eye, complaint of foreign body sensation, eye trauma with blunt or sharp mechanism, contact lens overwear, welding flash or arc eye, snow or chemical exposure. Always have fluorescein strips when you carry proparacaine.
Failing to remove soft contact lenses before application - the lens stains permanently and must be discarded. The other mistake is using fluorescein in a suspected open globe injury without first protecting the eye - if Seidel sign is the only finding you need, fine, but if penetration is grossly visible, shield first, transport for ophthalmology, do not manipulate further. A third mistake is reusing strips - they are single-use, and dipping the same strip in different eyes is a Pseudomonas transmission risk.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Fluorescein (Ophthalmic Stain)
| IV/IO | None (IV fluorescein for angiography is a specialty ophthalmologic procedure not relevant to tactical EMS). (None) |
| IM | None (None) |
| IN | None (None) |
| PO | None (None) |