A NOTE ON FI.U0RESCIN-C0L0R1NG AND THE 
ACTUAL CAUTERY IN CORNEAL ULCERS. 
BY 
G. E. de SCHWEINITZ, M.D., 
OPHTHALMIC SURGEON TO THE PHILADELPHIA AND CHILDREN’S HOSPITALS. 
FROM 
T HE MEDICAL N E W S, 
August 15, 1891. Reprinted from The Medical News, August 15, 1891.] 
A NOTE ON FLUORESCIN-COLORING AND THE 
ACTUAL CAUTERY IN CORNEAL ULCERS. 
By G. E. de SCHWEINITZ, M.D., 
OPHTHALMIC SURGEON TO THE PHILADELPHIA AND CHILDREN’S 
HOSPITALS. 
As is well known since the publications of Straub, 
Thomalla, and Fromm-Groenouw, a concentrated, two 
per cent, alkaline solution of fluorescin colors green 
any portion of the cornea deprived of its epithelium, 
while the healthy epithelium remains unaffected. At 
first this discovery seemed devoid of practical value, but 
it soon acquired diagnostic worth in detecting minute 
abrasions of the corneal surface, particularly when these 
were of traumatic origin. Perhaps its most important 
use has recently been suggested by Nieden (Central- 
blatt fur praktische Augenheilkunde, May, 1891), in 
connection with its value as an aid to the actual cautery 
in the treatment of ulcers of the cornea. This earnest 
advocate of the galvano-cautery in ocular therapeutics 
has more than once lamented the lack of exact means 
for determining how extensive should be the application 
of the glowing point of the instrument. In his last 
communication upon this subject he pointed out that he 
was rarely obliged to resort a second or third time to the 
use of the cautery, but in the very first instance suc- 
ceeded in applying the heated needle to the entire area 
of ulceration, in spite of the fact that he was without a 
method of outlining with absolute certainty the entire 
area which required destruction. This means is now at 2 
DE SCHWEINITZ, 
hand in the form of fluorescin, because, by its use, the 
border between the sound and the diseased area can be 
demonstrated with exactness. More than this, the depth 
of the ulceration and any outlying areas of infiltration 
deprived of their covering of epithelium are indicated 
by the green coloration. In common with a number of 
observers, I have often made use of fluorescin for the 
purpose of staining deep and superficial ulcerations of 
the cornea, and of demonstrating the rate of progress 
in the healing of any corneal ulceration, and the pres- 
ence of minute foreign bodies imbedded in the surface 
of this membrane. Quite recently, acting on the sug- 
gestion of Nieden, I have employed it in several cases 
of ulcer of the cornea, to which, afterward, the glowing 
point of a thermo-cautery was applied. Two cases will 
illustrate its value. 
Case I. (Philadelphia' Hospital.)—An adult with 
chronic trachoma: on the left side, in the stage of cica- 
trization ; on the right side, in the stage of ulceration of 
the follicles, with pannus. This eye, owing to exposure, 
took on a violent form of keratitis with dense pannus in 
the upper portion of the cornea, while in the lower half 
there appeared an irregularly crescent-shaped ulcer with 
sloping margins and outlying spots of infiltration. The 
entire cornea exhibited the well-known whitish infiltra- 
tion so common in this disease. The manipulation was 
as follows: An application of a few drops of a two per 
cent, solution of fluorescin (Cruebler’s fluorescin 2 per 
cent.; carbonate of soda 3.5 per cent.) was made to the 
affected eye. The entire crescent-shaped ulcer was 
colored a deep green, and, still more interesting, three 
of the more saturated whitish areas of infiltration situ- 
ated in the general haze of the cornea acquired a similar 
color. This at once became the guide for the proper 
application of the actual cautery. The ulcer itself and 
the three superficial spots were cauterized, or, in other 
words, all those spots which had been stained green CORNEAL ULCERS. 
3 
were subjected to this treatment. It seems to me, in a 
case of this character, that the three smaller areas cer- 
tainly would have been overlooked without the use of 
fluorescin, and their character of superficial ulceration 
undetected, owing to the obscuration produced by the 
general haze and development of vessels in the cornea. 
Case II. (Children’s Hospital.)—A child of about five 
years of age, with an ordinary phlyctenular keratitis, in 
the course of which a phlyctenular ulcer appeared below 
the centre of the cornea. In this stage the child was 
admitted to the wards, and the following manipulation 
performed: A few whiffs of ether were given to quiet 
the little patient, and the point of the cautery applied to 
the somewhat irregular ulcer and its slightly infiltrated 
margins. The eye was now washed out with boric acid 
lotion and a few drops of the fluorescin solution applied. 
It then became manifest that all ulcerated spots had 
been destroyed with the single exception of a small por- 
tion of the upper and inner margin, slightly distant from 
the main body of the ulcer, which at once assumed a 
deep-green, characteristic color. A second light applica- 
tion of the cautery to this spot destroyed the previously 
untouched area. 
Nieden calls attention in his communication to the 
very points which are illustrated in these two cases 
selected at random. He dwells particularly upon the 
fact that in serpentic ulcer of the cornea, beyond the 
well-known half-moon-shaped area of propagation, one 
or two small, sharply marked spots of infiltration are 
commonly present, but, owing to the diffuse opacity of 
the border-zone of the ulcer, not readily detectable, unless 
they are colored green by the instillation of fluorescin. 
Every surgeon must have seen a phlyctenule start at the 
border of the cornea, break down into an ulcer, push its 
way toward the centre with an advance guard of infil- 
tration and a rear guard of densely injected vessels, and 
with a strong tendency to perforate, or at all events 4 
CORNEAL ULCERS. 
to form a stubborn type of keratitis, which, on heal- 
ing, leaves a disfiguring stripe of opacity. In such a 
case a drop or two of the fluorescin mixture will ac- 
curately outline the extent of the ulcerated infiltration 
and give exact information as to where the point of the 
cautery should be applied, but more than all, as to what 
extent the destruction of the tissues should be carried. THE MEDICAL NEWS. 
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