Enhanced Fluorescein Staining for Dry Eye and Ocular Surface Evaluation

Overview:
Enhanced fluorescein staining is a diagnostic technique used to assess the health of the ocular surface, particularly in patients with dry eye disease. This non-invasive procedure helps eye care professionals detect damage or irregularities on the cornea and conjunctiva by highlighting areas of epithelial compromise.

Procedure Description:

1. Patient Preparation:
   The patient is seated comfortably at the slit lamp microscope. They are instructed to blink naturally and keep their eyes open as directed.

2. Fluorescein Application:
   A sterile fluorescein strip is moistened with a drop of saline or artificial tears and gently applied to the lower conjunctival sac. Alternatively, pre-filled fluorescein drops may be used. The dye spreads evenly across the ocular surface with blinking.

3. Examination:
   Using a slit lamp equipped with a cobalt blue filter (and optionally a yellow barrier filter for enhanced contrast), the clinician examines the ocular surface. Damaged or dry areas of the epithelium absorb the fluorescein dye and appear as bright green spots or patches.

4. Grading and Documentation:
   The pattern, intensity, and distribution of staining are evaluated and recorded. Grading scales such as the Oxford or NEI system may be used to assess the severity of dry eye and guide treatment decisions.

Clinical Significance:
Enhanced fluorescein staining allows for detailed visualization of epithelial defects, tear film instability, and areas of desiccation. It is particularly useful in diagnosing:

• Dry Eye Disease (DED)

• Punctate epithelial erosions

• Contact lens-related irritation

• Exposure keratopathy

• Ocular surface inflammation

Why It's Important:
This enhanced diagnostic tool helps in early detection and ongoing management of dry eye syndrome and other ocular surface disorders, leading to more effective and personalized treatment plans.