Version April 2023
Diagnostic staining: Ophthalmic: Strips: Moisten strip with sterile water, saline or ophthalmic fluid. Touch conjunctiva or fornix with tip of strip until adequately stained.
Ophthalmic angiography/angioscopy: Note: Prior to injection, an intradermal test dose of 0.05 mL may be used if an allergy is suspected. Evaluate 30-60 minutes following intradermal injection. A negative skin test does not exclude the potential for a reaction to occur.
IV: 500 mg as a single dose into antecubital vein; a dose of 200 mg may be appropriate in cases when a highly sensitive imaging system (eg, scanning laser ophthalmoscope) is used.
Oral (off-label route): 1 g of injection solution has been administered orally; clarity of photographs, particularly during early arterial phase, is reportedly poorer than photographs obtained following IV administration (Hara, 1998)
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustment provided in the manufacturer's labeling.
(For additional information see "Fluorescein: Pediatric drug information")
Diagnostic staining: Limited data available: Infants, Children, and Adolescents: Ophthalmic: Strips: Moisten strip with sterile water, saline, or ophthalmic fluid. Touch conjunctiva or fornix with tip of strip until adequately stained (Kliegman 2015).
Ophthalmic angiography:
Test dose: Infants, Children, and Adolescents: Intradermal: Prior to use, an intradermal test dose of 0.05 mL may be used if an allergy is suspected. Evaluate 30 to 60 minutes following intradermal injection. A negative skin test does not exclude the potential for a reaction to occur.
Diagnostic dose:
Infants: Limited data available: IV: Reported range: 7.7 to 10 mg/kg as a single dose followed by a saline flush (Azad 2008; Lepore 2011; Lepore 2014; Tahija 2013)
Children and Adolescents: IV: 7.7 mg/kg (actual body weight) as a single dose into antecubital vein; maximum dose: 500 mg/dose
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as sodium:
AK-Fluor: 10% (5 mL); 25% (2 mL)
Fluorescite: 10% (5 mL)
Strip, Ophthalmic, as sodium:
Bio Glo: 1 mg (100 ea, 300 ea)
Fluor-I-Strips A.T.: 1 mg (300 ea)
Ful-Glo: 0.6 mg (300 ea); 1 mg (100 ea)
GloStrips: 1 mg (100 ea) [orange flavor]
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous, as sodium:
Fluorescite: 10% (5 mL)
Generic: 25% ([DSC])
Solution, Ophthalmic, as sodium:
Generic: 2% (0.3 mL)
IV: Inject into the antecubital vein at a rate of ~1 mL/second using a 23-gauge butterfly needle attached to a small syringe. Prior to turning off room light, ensure extravasation has not occurred. Immediate treatment for anaphylaxis (including epinephrine) should be available or a test dose may be advised in some patients. Do not mix or dilute with other solutions or drugs; flush IV cannulas before and after drugs are administered. Luminescence usually appears in the retina and choroidal vessels in 7 to 14 seconds. Maintain venous access following procedure in the event treatment is needed for anaphylaxis.
Oral (off-label route): The solution for injection has been administered orally in certain patients. Four grams of sugar or 1 teaspoonful of artificial sweetener may be added to decrease the bitterness of the solution. Luminescence appears in 10 to 15 minutes following oral administration (Hara 1998).
Ophthalmic: Strips: Fluorescein impregnated tip should be moistened prior to application. Strip should be applied to conjunctiva or fornix. For best results, patient should blink several times after application.
Ophthalmic: Strips: In infants, children, and adolescents, fluorescein impregnated tip should be moistened prior to application. Strip should be applied to conjunctiva or fornix. For best results, patient should blink several times after application.
Parenteral: IV: In infants, children, and adolescents, a 23-gauge butterfly needle inserted into an antecubital vein attached to a small syringe is suggested for administration. Prior to turning off room light, steps should be taken to ensure the needle has not extravasated. Immediate treatment for anaphylaxis (including epinephrine 1 mg/mL) should be available and premedication or a test dose may be advised in some patients. Inject the dose over 5 to 10 seconds. Luminescence appears in the eye 7 to 30 seconds following injection. Maintain venous access following procedure in the event treatment is needed for anaphylaxis.
Ophthalmic angiography/angioscopy (injection): Diagnostic aid in ophthalmic angiography or angioscopy of the retina and iris vasculature
Ophthalmic diagnostic staining (strips): To stain the anterior segment of the eye for procedures (such as fitting contact lenses), disclosing corneal injury, and in applanation tonometry
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reactions associated with use of the injection. Frequency not defined.
Cardiovascular: Arterial ischemia (basilar; rare), hypotension, shock, syncope
Central nervous system: Convulsions (rare), dizziness (Kwan 2006), headache, nerve palsy (localized; [Kwan 2006]), seizure (rare; [Kwan 2006])
Dermatologic: Pruritus, rash at injection site, skin discoloration (yellow), urticaria
Gastrointestinal: Dysgeusia, gastrointestinal distress, nausea (common), vomiting
Genitourinary: Urine discoloration (bright yellow)
Hematologic & oncologic: Hemolytic anemia (Kwan 2006), sickle cell disease (Kwan 2006, Acheson 1985)
Hypersensitivity: Anaphylaxis, hypersensitivity reaction
Local: Extravasation, inflammation at injection site
Respiratory: Bronchospasm, pulmonary edema (acute; [Kwan 2006])
Hypersensitivity to fluorescein or any other component of the formulation
Concerns related to adverse effects:
• Anaphylaxis/hypersensitivity reactions: Hypersensitivity and anaphylactic reactions may occur (death has been reported rarely); immediate treatment (including epinephrine) should be available. Serious intolerance reactions may be induced; history of adverse reaction to fluorescein or allergic reaction to foods or drugs, such as urticaria, asthma, eczema, or allergic rhinitis, may increase risk. Premedicating some patients (eg, antihistamines, corticosteroids) may be advisable. An intradermal skin test may be performed prior to use when allergy is suspected; however, a negative skin test does not rule out the potential for a reaction to occur.
• Gastrointestinal effects: Nausea and/or vomiting and gastrointestinal distress occur commonly within the first few minutes following injection; these reactions usually subside within 10 minutes.
• Skin/urine discoloration: Following use of the injection, skin may temporarily turn a yellow color within a few minutes of administration and usually fades in 6 to 12 hours. Urine may appear bright yellow for 24 to 36 hours.
Disease-related concerns:
• Allergies/asthma: Respiratory reactions may occur, especially in patients with a history of allergies or bronchial asthma; use with caution.
Special populations:
• Contact lens wearers: Ophthalmic products should not be used in patients with soft contact lenses, will cause them to discolor. Flush eyes with saline following use and wait at least 1hour prior to replacing contact lenses.
Dosage form specific issues:
• Injection: Avoid extravasation; severe local tissue damage may result, including skin sloughing, superficial phlebitis, subcutaneous granuloma, and toxic neuritis along the median curve in the antecubital area. Following extravasation, severe pain may last up to several hours. Discontinue immediately if extravasation occurs.
None known.
There are no known significant interactions.
Fluorescein was found in the amniotic fluid following angiography conducted in a patient ~34 weeks' gestation (Shekleton 1980).
Outcome data following fluorescein use in pregnant patients are limited (Halperin 1990; Interlandi 2021; Lin 2012; Olk 1991).
Fluorescein is present in breast milk.
Measurable concentrations can be detected for at least 4 days following injection. Fluorescein 500 mg injection was administered following delivery to a patient for angiography. Fluorescein breast milk concentrations were 372 ng/mL 6 hours after the dose and decreased to 170 ng/mL 75 hours after the injection (Maquire 1988). Fluorescein has also been detected in breast milk following use of a 2% ophthalmic drop (Mattern 1990).
Injection: Hypersensitivity reactions (during procedure and after)
Fluorescein sodium, a fluoresce dye, responds to wavelengths between 465-490 nm of electromagnetic radiation and light, and fluoresces at wavelengths of 520-530 nm.
Distribution: Vd: 0.5 L/kg
Metabolism: Rapidly metabolized to fluorescein monoglucuronide (~80% is metabolized 1 hour following IV administration)
Excretion: Urine; systemic clearance essentially complete 48 to 72 hours after dose
Solution (Fluorescite Intravenous)
10% (per mL): $11.57
Strip (Bio Glo Ophthalmic)
1 mg (per each): $0.23
Strip (Fluor-I-Strips A.T. Ophthalmic)
1 mg (per each): $0.26
Strip (Ful-Glo Ophthalmic)
0.6 mg (per each): $0.15
1 mg (per each): $0.19
Strip (GloStrips Ophthalmic)
1 mg (per each): $0.15
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