OCULAR PHARMACOLOGY || DYES
detection of corneal and conjunctival lesions, such
Fluorescein Sodium
 one of the most widely used dyes for ophthalmic
use
 hydrophilicity, low toxicity, 50% water soluble at
15°
 Early ocular applications were used in detection of
corneal ulcers and aqueous flow, followed shortly
thereafter by retinal diagnostic application
 a yellow acid dye of the xanthene series
 molecular weight is 376 Da
 Absorbs 493 nm and emits at approximately 520
nm
 fluorescein is a weak acid
 is highly susceptible to bacterial contamination,
especially by Pseudomonas aeruginosa, which
grows easily in the presence of fluorescein
 fluorescein can directly stain diseased human
corneal cells and rabbit epithelial cells.
 Fluorescein staining of the tear film is a major aid
in the fitting of rigid gas-permeable contact lenses.
o Observation of the fluorescein-stained tear
film with an UV light or the cobalt blue
filter of the slit lamp allows determination
of the fit of the lens
 is essential for assessing the integrity of the cornea
in contact lens wearers.
PH of the solution and its ionic state
 Below pH 2, the cationic form predominates, and a
weak blue-green fluorescence occurs
 Between pH 2 and 4 the cations dissociate to
neutral molecules
 At pH 7 negative ions prevail and are associated
with a brilliant yellow-green fluorescence
 Further increases in pH above 8 reduce the
intensity of fluorescence.
Factors that can alter the fluorescence of fluorescein in
solution
 concentration
 the pH of the solution
 the presence of other substances
 the intensity and wavelength of the absorbed light
Uses/application:
 Topical in the form of a solution
 or by fluorescein-impregnated filterpaper strips
 Injection (Intravenous)
Topical Ocular Applications
 Instillation of the dye in the cul-de-sac allows
as:
o abrasions, ulcers, and edema
 aids in the detection of foreign bodies
 When the cobalt blue filter of the slit lamp is used,
the epithelial defect usually appears outlined in
vivid green fluorescence.
 the yellow barrier filter will be used for staining
assessment and for other tests such as fluorescein
breakup time
Intravenous Applications
 Intravenous fluorescein is used extensively to
delineate vascular abnormalities of the fundus and
occasionally to evaluate anterior segment blood
and aqueous flow.
 Flourescein Angiography
o In the bloodstream fluorescein is excited
by a wavelength of 465 nm and emits a
wavelength of 525 nm.
o fluorescein binds to albumin and red blood
cells
Adverse effects:
 Mild Adverse rexn: nausea, accompanied less
frequently by vomiting
o nausea usually occurs 15 to 30 seconds
after injection and subsides within several
minutes.
 Moderate adverse reactions: fainting,localized
reactions,and urticaria (hives)
 No severe rexn
Contraindication:
 allergy (hypersensitivity)
FLUOREXON
 a molecule similar in fluorescent characteristics to
that of fluorescein
 ethylfluorescein tetrasodium salt
 less readily absorbed by the soft lens material,
which renders it useful in fitting and evaluating
soft and hybrid design lenses
 molecular weight of approximately 710 Da
 hydrophilic dye due to its multiple polar moieties
 fluorexon has a paler yellow-brown color
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  fluorexon is also vulnerable to bacterial
contamination
 it is dispensed as single-dose sterile pipettes
 In clinical use fluorexon has proven nontoxic to
ocular tissue
Uses:
 aid in the fitting of soft contact lenses
 useful in evaluating hybrid designs,such as the
SoftPerm lens
 allows visualization of the tear film under the rigid
portion of the lens without discoloring the
hydrogel portion.
Adverse Effects:
 Fluorexon stains the soft lens if it remains in
contact with the lens for more than a few minutes
 Occasional conjunctival injection may occur
Contraindications:
 not recommended for use with highly hydrated
soft lenses having a water content of 60% or
higher
o lens can absorb significant amounts of dye,
resulting in unwanted lens discoloration
ROSE BENGAL
 Widely used in the diagnosis of ocular surface
disease
 recent evidence suggests that it is not a vital dye
but one that may actually cause toxicity and cell
death under certain circumstances
 TIssues stained with rose bengal display a vivid
pink or magenta color when viewed with white
light
 formulated as a 1% solution and in the form of
sterile impregnated paper strips or extraocular
irrigation solution
 is a photoreactive compound.
 With excitation light it generates singlet oxygen,
which may be responsible for its ability to kill
microorganisms such as bacteria and viruses.
 binds strongly to damaged cells
Uses:
 differential diagnosis of dry eye syndromes
 helpful in the evaluation of most types of corneal
and conjunctival lesions, including abrasions,
ulcerations, and foreign bodies, and conjunctival
dysplasia or metaplasia
Side effects:
 Cells exposed to the dye demonstrated
instantaneous morphologic changes, loss of
cellular motility, cell detachment, and cell death
Contraindications:
 Because rose bengal also stains skin,clothing,and
contact lenses, contact with these entities should
be avoided.
LISSAMINE GREEN
 is a vital stain that stains degenerate cells, dead
cells, and mucus in much the same way as rose
bengal
 also widely used in the food industry as a colorant
 molecular weight of 576.6 Da
 currently available in sterile strips
 It may be useful when a patient is known to be
sensitive to rose bengal
 Lissamine greenstains membrane-damaged
epithelial cells as well as corneal stroma in a
manner similar to that of fluorescein and, like rose
bengal, also binds to the nuclei of severely
damaged cells
Side effects:
 no ocular irritation, and no other adverse effects
have been reported
INDOCYANINE GREEN
 clinical diagnostic tool
 ICG is a water-soluble tricarbocyanine dye
 molecular weight, 774.96 Da
 a peak absorption in the near-infrared spectrum at
805 nm and maximal emission at 835 nm
Photography in the near-infrared
 region also enhances angiogram viewing in the
presence of media opacities and subretinal
exudation of fluid or blood
 ICG is rapidly and completely bound to plasma
proteins after intravenous injection in blood
 primary use is as a fluorescent dye for retinal and
choroidal angiography
Adverse Rxn:
 severe allergic reactions have been reported
 transient nausea and vomititng, hives
Contraindication:
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  should not be used in patients with sensitivities to
iodine or shellfish or in patients at high risk for
anaphylactic reaction

METHYLENE BLUE

 a vital stain (Urolene blue), has properties similar

to those of rose bengal
 It can stain both devitalized cells and mucus and
corneal nerves.
 Useful for staining the lacrimal sac before
dacryocystorhinostomy and outlining glaucoma
filtering blebs, and it may prove useful in
gonioscopic laser sclerostomy
 absorbance at 660 nm
 ar weight of 373.91 Da
 used as a 5% solution, and benzalkonium chloride
may be added to the dye solution to enhance
sterility.
 Precipitates in alkaline solution
 Can also be administered intracamerally to stain
the crystalline lens capsule to aid in visualization
during cataract surgery

Adverse rxn:

 When topically applied methylene blue can be

fairly irritating to ocular tissue.

Contraindication:

 Methylene blue is contraindicated in patients

allergic to the dye

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