A NEW VITAL DYE IN THE MANAGEMENT OF EXTERNAL OCULAR DISEASES Alexandra Mieth A, MD, FRCSC Eduardo Arenas A, MD, FACS Fundación Santa Fe de Bogotá Colombia

1. TOLUIDINEBLUE
Alexandra Mieth A, MD, FRCSC
Eduardo Arenas A, MD, FACS
Fundación Santa Fe de Bogotá
Colombia
A NEW VITAL DYE
IN THE MANAGEMENT OF EXTERNAL OCULAR DISEASES

2. VITAL DYE
 Term
introduced
by Ehrlich in
1886
 Staining of
Bacteria,
protozoa,
cells, tissues
in living
state
TOLUIDINEBLUE

3. TOLUIDINE BLUE
Clinical Study
1% Toluidine Blue in Proparacaine
Utilized routinely in 6000 cases
July 1994 to July 2002
Comparison:
 Fluorescein
 Rose Bengal
 Toluidine blue
TOLUIDINEBLUE

4. VITAL DYES USED IN
OPHTHALMOLOGY
FLUORESCEIN Pflüger 1888
ROSE BENGAL Norn 1914
METHYLEN BLUE Schirmer 1950
LISSAMINE GREEN Norn 1973
SULPHORHODAMINE Eliason 1990
TOLUIDINE BLUE Arenas 1998
TOLUIDINEBLUE

5. VITAL DYES
FLUORESCEIN Denuded epithelium
ROSE BENGAL
METHYLEN BLUE Dead or degenerated cells
LISSAMINE GREEN
SULPHORHODAMINE Surface abnormalities
TOLUIDINE BLUE Subtle cell alterations
TOLUIDINEBLUE

6. anización
APPLICATIONS
TOLUIDINEBLUE

7. Eyelash malposition
1. Dry Eye
TOLUIDINEBLUE
2.Herpes
3.Symtomatic pterygium
APPLICATIONS
Conjuntivitis
Malignant cells
HCL Trauma

8. 4.”Rubbing sign”
5.Loose sutures
6.Glandular occlusion
APPLICATIONS
Lid margins
Epithelial loss
Trauma
Mild cell inflamation
TOLUIDINEBLUE

9. anización
 4,5,6,7 tetracloro-2´4´5´7´ tetraiodo
fluorescein
 Concentration:0.5-%
 Acid
 Phototoxic
 Fading dye
 Burning
 Aneritre filter
 Denuded or damaged cells, mucous
strands
 Abscence of preocular mucin film
TOLUIDINEBLUE
Rose Bengal

10. TOLUIDINEBLUENUMERICAL SCORING FOR THE
INTENSITY OF STAINING
I
II
III

11. Different Dyes
imagen
imagen
imagen
imagen
Toluidine Blue 1%
C15H16CIN3S
Rose Bengal 0.5-1%
4,5,6,7 tetracloro-2´4´5´7´ tetraiodo fluorescein
Fluorescein 1-10%
Anionic sodium fluorescinate
Lissamine green
Synthetic organic acid, two aminophenyl groups
• Diffusion into intercellular
spaces from surface defect
• Maximal fluorescence 0.08g/l
• Cobalt blue filter
• Absence of preocular tear film
• Photochemical interaction
• Burning
• Membrane damaged cells
• Potential toxic risk not known
• Antiviral effect
TOLUIDINEBLUE
• Denuded epithelium
• Dead or degenerated cells
• Burning

12. FLUORESCEIN
 Non-toxic
 Fading dye
 Diffusion into
intercellular spaces
 Cobalt filter
 Maximal fluorescence:0.08g/l
 Anonic sodium fluorescinate
 Concentration:0.25-1%
TOLUIDINEBLUE

13. New Vital dye
Highly sensitive
No side effects
Early and late stainning
No need for special filters
Stains also skin deffects
TOLUIDINEBLUE CONCLUSIONS

14. anización
 Chodosh J, Dix RD, Howell RC, Stroop WG, Tseng
SC. Staining and activity of sulforhomine B and
lissamine green. Invest Ophthalmol Vis Sci 1994;
35:1046
 Straub M. Fluorescinlösung als ein
diagnostisches Hülfsmittel für
Hornhautkrankungen. Zentralbl. Augenheilkunde
1888;12:75
 Norm MS. Vital staining of cornea and
conjunctiva. Acta Ophthalmol 1962; 40:389
 Freestra RPG, Tseng SC. Comparison of
fluorescein and rose bengal staining.
Ophthalmol 1992; 99:605
REFERENCESTOLUIDINEBLUE