Fluorescein Dye is used during diagnostic procedures. It is used during ophthalmic angiography and other ophthalmic diagnostic procedures.

Fluorescein Uses:

• Ophthalmic angiography/ angioscopy (injection):

  • It has been used widely for diagnostic aid in ophthalmic angiography or angioscopy of the retina and iris vasculature.

• Ophthalmic diagnostic staining (strips):

  • It is also used to stain the anterior segment of the eye for procedures such as fitting contact lenses, disclosing corneal injury, and in applanation tonometry

Fluorescein Dose in Adults

Fluorescein Dose in Diagnostic staining:

• Ophthalmic: It is used as strips. Process: Moisten strip with sterile water, saline, or ophthalmic fluid. Touch conjunctiva or fornix with the tip of the strip until adequately stained.

Fluorescein Dose in Ophthalmic angiography/ angioscopy:

Note: Before 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 rule out the potential for a reaction to occur.

• IV:
  • it is given as 500 mg as a single dose into the antecubital vein. A dose of 200 mg can be appropriate in cases when a highly sensitive imaging system (eg, scanning laser ophthalmoscope) is used.
• Oral (off-label route):
  • It is given as 1 g of injection solution orally. The clarity of photographs, particularly during the early arterial phase, is reportedly poorer than photographs obtained following IV administration.

Fluorescein Dose in Childrens

Fluorescein Dose in the Diagnostic staining:

• Infants, Children, and Adolescents:

  • Ophthalmic: In the form of a strip, it is used as:
    • Moisten strip with sterile water, saline, or ophthalmic fluid. Touch conjunctiva or fornix with the tip of the strip until adequately stained.

Fluorescein Dose in Ophthalmic angiography:

• Test dose:

  • Infants, Children, and Adolescents:

    • Intradermal: Before its use, an intradermal test dose of 0.05 mL might 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: its reported range is 7.7 to 10 mg/kg as a single dose followed by a saline flush.

  • Children and Adolescents:

    • IV: it is given as 7.7 mg/kg of actual body weight as a single dose into the antecubital vein. The maximum dose is 500 mg/dose.

Pregnancy Risk Factor C

• A negative outcome in animal reproduction studies is not yet known.
• Fluorescein is used in pregnancy to provide information about the outcome of pregnancy.

Use fluorescein while breastfeeding

• Fluorescein can be excreted from breast milk when given by IV or eye.
• After injection, concentrations of significant amounts can be detected for up to 4 days. The literature recommends that milk be pumped and then discarded within this time frame.

Fluorescein Dose in Kidney Disease:

No dose adjustments are required in renal disease.

Fluorescein Dose in Liver disease:

No dose adjustments are required in hepatic impairment.

Side effects of Fluorescein:

• Cardiovascular:

  • Arterial Ischemia (Basilar; Rare)
  • Hypotension
  • Shock
  • Syncope

• Central Nervous System:

  • Convulsions (Rare)
  • Dizziness
  • Headache
  • Nerve Palsy (Localized)
  • Seizure

• 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
  • Sickle Cell Disease

• Hypersensitivity:

  • Anaphylaxis
  • Hypersensitivity Reaction

• Local:

  • Extravasation
  • Inflammation At Injection Site

• Respiratory:

  • Bronchospasm
  • Pulmonary Edema (Acute; [Kwan 2006])

Contraindications to Fluorescein:

A contraindication is a hypersensitivity to fluorescein and any component used in its manufacture.

Warnings and precautions

• Anaphylaxis/ Hypersensitivity reactions:

  • Hypersensitivity or anaphylactic reactions may occur. Fatalities are rare. It is important to have immediate access to epinephrine and other treatment options nearby.
  • Severe intolerance reactions may be possible. It is possible to have serious intolerance reactions if you have had an allergic reaction to fluorescein, food or drug, such as urticaria or asthma.
  • It is recommended to administer antihistamines or corticosteroids to some patients.
  • If an allergy is suspected, an intradermal test of the skin may be done before you use the product. A negative skin test doesn't rule out the possibility of a reaction.

• Gastrointestinal effects:

  • Nausea, vomiting, and stomach pain can all occur within the first few minutes of IV administration. These symptoms usually disappear within 10 minutes.

• Skin/urine discoloration:

  • The injection may temporarily cause the skin to turn yellow. This usually disappears within 6 to 12 hours. For 24 to 36 hours, urine may appear bright yellow.

• Allergies/asthma

  • Patients with allergies or bronchial asthma have reported symptoms such as a heightened risk of developing respiratory problems. It is important to exercise caution.

Monitoring parameters:

• Hypersensitivity reactions should be observed.

How to administer Fluorescein?

IV:

• Inject into the antecubital vein at a rate of approximately 1 mL/second using a 23-gauge butterfly needle attached to a small syringe.
• Prior to turning off the 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 the 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.

Ophthalmic: Strips:

• Fluorescein impregnated tip should be moistened prior to application. The strip should be applied to the conjunctiva or fornix. For best results, the patient should blink several times after application.

Mechanism of action of Fluorescein:

• Fluorescein sodium is a fluorescing dye that responds to electromagnetic radiation wavelengths between 465-490nm and light wavelengths.
• It fluoresces at wavelengths from 520-530nm.

Metabolism

• Fluorescein monoglucuronide is rapidly metabolized (80% is metabolized within one hour of IV administration).

Excretion:

• It is excreted through urine.
• The systemic clearance is complete within 48 to 72 hours of the last dose.

International Brand Names of Fluorescein:

• AK-Fluor
• Bio Glo
• Fluor-I-Strips A.T.
• Fluorescite
• Ful-Glo
• GloStrips
• Odan-Fluorescein
• Aka-Fluor
• Cendo Fluorescein
• Colircusi Fluoresceina
• Fluocyne
• Fluoftal
• Fluor-I-Strip
• Fluoralfa
• Fluore Stain Strips
• Fluorescein
• Fluoresceina
• Fluoresceina Oculos
• Fluoresceine
• Fluoresceine Ophtadose
• Fluoresceine SDU Faure
• Fluoresceinnatrium
• Fluorescite
• Fluorets
• Flurocin
• Minims Fluorescein Sodium
• Minims Fluoresceine
• Ophth-fluorstrip
• Optifluor Diba
• Retinofluor

Fluorescein Brand Names in Pakistan: