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• To date, voluntary cooperation between the pharmaceutical industry, the FDA, and the American Academy of Ophthalmology has been very effective in meeting the interest of patient safety
• No other topical medications should carry the same color
• Recommended color codes


  • Light Green (Pantone 373C) - Adrenergic Agonist Combinations
  • Purple (Pantone 2583) - Adrenergic Agonists
  • Tan (Pantone 467) - Anti-Infectives
  • Gray (Pantone 4) - Anti-Inflammatory, NSAIDs
  • Pink (Pantone 197) - Anti-Inflammatory, Corticosteroids
  • Olive (Pantone 5763C) - Anti-Inflammatory, Immunomodulators
  • Green (Pantone 348) - Beta-Blocker Combinations
  • Dark Blue (Pantone 281) - Beta-Blockers
  • Yellow (Pantone Yellow C) - Carbonic Anhydrase Inhibitors
  • Orange (Pantone 1585) - Cytotoxic
  • Black - Miotics
  • Dark Green (Pantone 348) - Mydriatics And Cycloplegics
  • Red (Pantone 1797) - Prostaglandin Analogues
  • Turquoise (Pantone 326) - Topical anesthetics and OTC eye drops
• As new classes of drugs are developed, it may be necessary to assign new colors to additional classes of drug products
• However, given the potential for confusion with existing color-coding, the Academy recommends introducing new colors only when those agents are associated with risk to patient safety
• It may be necessary to consider alternative identification technologies, which further reduce the likelihood of drug errors
• Local Acting Dyes


  • Trypan Blue
  • Lissamine Green
  • Indocyanine Green
  • Methylene Blue
  • Fluorescein Sodium
  • Rose Bengal
• Trypan Blue


  Concentration: 0.15% for vitreoretinal and 0.06% for cataract surgery. Used to assess corneal endothelial cell viability. Does not penetrate the capsule, permitting visualization of the anterior capsule in contrast to the non-stained lens cortex and inner lens material. Selectively stains the Tenon's capsule, and hence is used after enucleation surgeries during layered closure, without entrapment of conjunctiva in the Tenon's capsule. In the posterior segment of the eye, it stains ERM blue on instillation after fluid/air exchange.
• Lissamine Green


  Concentration: 1%, 2%, 3% liquid dyes or 1.5mg dye impregnated strips. High affinity for staining dead and degenerated cells, including mucous strands. Localization of the dye to the nucleus is seen. Staining is increased in areas of disrupted cell junctions. Preferred dye for staining the bulbar conjunctiva. Used for diagnosis of Dry eye disease, to ascertain proper fitting of contact lens, and to look for any contact-lens induced conjunctival staining.
• Lissamine green


  Dye that has a peak absorption at the red end of the visible spectrum (630nm)
• Using a red-free filter

  Absorbs the wavelength transmitted, and shows the stained areas as black
• Lissamine green


  Preferred dye for staining the bulbar conjunctiva
• Uses of lissamine green

  • Diagnosis of Dry eye disease
  • In Sjogren's syndrome suspects - to rule out Keratoconjunctivitis sicca
  • To ascertain proper fitting of contact lens, and to look for any contact-lens induced conjunctival staining
  • In patients with symptoms of dry eye disease but no clinical signs, can be used to assess lid margins for lid wiper epitheliopathy
• Lissamine green dye impregnated strips

  • Cause no ocular discomfort, and can be used in lieu of the 1% solution
  • When it comes to liquid formulations, lissamine green is preferred over Rose Bengal
  • Better visibility especially in cases of suspected lid wiper epitheliopathy due to the inherent color of the dye, as compared to Rose Bengal
  • Less degree of ocular toxicity as compared to Rose Bengal
  • Important in staining conjunctiva in superior limbic keratoconjunctivitis
• Lissamine green


  At concentrations of 2% and above, patient discomfort starts to set in
• Lissamine green


  A larger amount of stain is required as compared to fluorescein. The stain may have to be repeated after three to five minutes to aid in further examination
• Lissamine green


  Not contact lens compatible, therefore, after use in contact-lens wearers, irrigate the eyes with saline
• Indocyanine green (ICG)


  • 40mg in 2ml for IV injections
  • 0.05% to 0.5% for posterior segment surgeries, the concentration of the dye used for ILM [internal limiting membrane] staining depends upon the surgeon
  • The dye comes in a 25-mg vial of ICG, which is mixed with 5 mL of the aqueous solvent that comes with it to yield the 5 mg/mL (0.5%) concentration dye, which is used to stain the anterior capsule in cataract surgeries
• Indocyanine green (ICG)


  • The dye has a high affinity for collagen type IV (which is found in basement membrane) and laminin. Both of these are found in a high concentration in the internal limiting membrane of the retina. Hence, the dye is the used for staining the ILM during vitreoretinal procedures
  • When injected intravenously, 98% percentage of the dye remains plasma protein bound. The dye cannot diffuse out of the intravascular compartment, and hence is used in imaging the choroidal vasculature in ICGA
  • The dye shows a phenomenon called decomposition, where once it is diluted in any solvent and exposed to light, ICG may undergo various chemical reactions by self-sensitized oxidation because it is chemically unstable. This can cause ocular toxicity, especially to the retina
• Uses of indocyanine green (ICG)

  • For staining the anterior capsule during cataract surgery
  • In chromovitrectomy to visualise the ILM
  • In ICGA, to visualise choroidal circulation, and help in the diagnosis of conditions like polypoidal choroidal vasculopathy, choroidal neovascular membrane, age related macular degeneration (wet), and posterior uveitis
• Indocyanine green (ICG)


  • During cataract surgeries, as compared to other capsular dyes, ICG gets washed out very quickly
  • ICGA is generally better tolerated than FFA, and is also the preferred method in eyes with media opacities. (As infrared light is less scattered than white light, a clearer picture can be obtained). In addition to this, the infrared rays that are used in ICGA can penetrate the ocular pigments, and give a clearer fundus picture in as compared to FFA
• Indocyanine green (ICG)


  For use in anterior capsule staining in cataract surgery, the dye has to be reconstituted and diluted. This has to be followed by filtration to prevent undissolved particles from entering the eye before use
• Indocyanine green (ICG)


  The property of decomposition is a major deterrent in using ICG in posterior segment surgeries, since it can cause retinal toxicity which is worsened on exposure to light
• Disadvantages of using indocyanine green (ICG)

  • Can remain in the vitreous after surgery
  • Can seep through macular hole during surgery, and cause RPE damage post-op
  • Can deposit permanently on the optic disc after surgery
  • Use in intraocular surgery is not approved by the FDA
• It is advised that ICG is injected into a fluid filled posterior segment so as to minimize contact with and subsequent damage to the macula
• In view of the discovery of an iodine free alternative, Infracyanine Green (IFCG) with all the staining properties of ICG, IFCG is now preferred over ICG for ILM staining in view of lesser ocular toxicity
• Methylene blue


  1% liquid dye
• Methylene blue


  • Dark green crystals or crystalline powder with bronze luster. Odorless; stable in air
  • Absorption max: 668, 609 nm. Soluble in water and chloroform; sparingly soluble in alcohol
  • Deep blue solution in water or alcohol. Forms double salts (Methylene blue trihydrate)
  • Slight odor
• Uses of methylene blue


  • Used as a stain in bacteriology, a chemical reagent, an antimethemoglobinemic drug, a polymerization inhibitor, and a temporary hair colorant; also used as a paper, textile, and leather dye
  • For Irrigation of lacrimal sac prior to dacryocystorhinostomy
• Methylene blue


  • Has bacteriostatic property
• Methylene blue


  More eye irritation (thus combined with anesthetic)
• Fluorescein sodium


  • Fluorescein strip, each containing 0.6mg to 1mg of the dye
  • 1% to 2% solution also available in a bottle form
  • IV injection preparations for FFA (Fluorescein Fundus Angiography)
  • 10% dye in a 5ml vial
  • 20% dye in a 2ml vial
• Fluorescein sodium


  • Orange, water soluble dye that adheres to basement membrane and can therefore highlight areas of epithelial breakdown
  • Fluorescence is the ability of a molecule to absorb light of a lower wavelength and emit light of a higher wavelength. In case of fluorescein, the molecule absorbs light in the blue spectrum (490nm); and emits yellow-green light of a higher wavelength (530nm). This property is made use of in a variety of settings for various diagnostic purposes
  • When injected intravenously, the dye is only 70% plasma protein bound, and the rest is free. This property is made use of in fundus fluorescein angiogram (FFA)
• Uses of fluorescein sodium

  • Diagnosis of dry eye disease
  • Standardized grading of corneal and conjunctival staining
  • Measurement of TBUT (tear film breakup time)
  • Tear meniscus height
  • Identifying and monitoring corneal epithelial defects, corneal ulcers, corneal abrasions
  • Applanation tonometry
  • Perforating injury - Seldel's test: If a perforation and active leak exist, the fluorescein is diluted by the aqueous and will appear as a yellow-green stream (of the diluted dye) within the dark orange (concentrated) dye. This is best appreciated while using the blue filter on the slit lamp
  • Nasolacrimal duct patency Jones dye disappearance test: 1% to 2% fluorescein is instilled into the conjunctival sac of the eye being tested, and a cotton bud is placed in the inferior meatus
  • Trauma to canaliculus: In case of eyelid trauma, 2% dye is injected in the lacrimal apparatus using a syringe for Identification of canalicular ends to help in repair of the canaliculus
  • Fluorescein Fundus Anglography/FFA - 5ml of 10% or 20% fluorescein is given as an IV bolus injection. A series of photographs are then taken through special filters to image vasculature and other properties in various pathologies such as diabetic retinopathy, retinal vein occlusions, age related macular degeneration (wet), and macular ischemia
  • Cobalt blue excitation filter - Incident white light is passed through this to excite the fluorescein molecules in the retinal and choroidal circulation
  • Yellow-green barrier filter - Absorbs any reflected blue light from the eye, while allowing only yellow-green light to pass through
  • Contact lens fitting
  • Off-label intraocular use in posterior segment surgeries to stain the vitreous
• Fluorescein sodium


  • Ready to use ophthalmic strips with impregnated dye
  • Does not cause ocular irritation in concentrations up to 3% when used topically
  • No ocular toxicity
• Fluorescein sodium


  • Allergy to fluorescein dye can cause a variety of symptoms, especially if used intravenously
  • It is always better to have a crash cart ready while doing a procedure such as FFA. Cautious intravenous use is recommended in renal failure, severe asthma and pregnancy
  • Compared to its use in imaging retinal vasculature, it is not as effective in delineating choroidal vasculature
• Fluorescein


  Dye used in ophthalmic procedures to visualize the retinal and choroidal circulation
• Fluorescein angiography procedure


  1. Cobalt blue excitation filter - Incident white light is passed through this to excite the fluorescein molecules in the retinal and choroidal circulation

  2. Yellow-green barrier filter - Absorbs any reflected blue light from the eye, while allowing only yellow-green light to pass through
• Rose Bengal


  Halide derivative of fluorescein that stains dead and devitalized cells including mucous strands on ocular surface
• Double vital staining


  Use of 1% flourescein + 1% Ilssamine green together In diagnosis of ocular surface disorders. This is done for combined assessment of corneal and conjunctival surface evaluation.