Doctors and students
debate furiously over applanation tonometry with either
Fluress or Proparacaine and fluorescein. Both have
adherents. I like using fluorescein and proparaine when I
suspect ocular surface disease or keratitis. I instill the
fluorescein just after visual acuities, inspect the cornea
and thereafter the Proparacaine for tonometry. Right after
that, I'll add the miydriatics and then refract.
Unlike the former
approach, I'll use Fluress if I've already decided there is
a dry eye problem or I don't suspect any corneal
irregularities. I like Fluress, because it is only one drop,
is quick, and can withstand repeated reflex tearing. The
downside is its persistence and its tendency to have thick
mire rings.
In summary, I think
doctors should be adept at both methods and have both
available in each examination room.