Drugs List

Therapeutic Indications

Uses

Foreign bodies in the eye - detection of
Ophthalmic lesions - detection of
Tonometry - measurement of intraocular pressure

Contraindications

Soft contact lenses

Precautions and Warnings

Breastfeeding
Pregnancy

Advise patient blurred vision may affect ability to drive/operate machinery
For single use only
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Advise patient to avoid touching the eye/other surfaces with container tip

Pregnancy and Lactation

Pregnancy

Case studies of fluorescein in pregnant women have not revealed any unwanted foetal effects. Fluorescein crosses the placenta; passage to the foetus due to systemic circulation should be expected, but is unlikely to produce unwanted effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Following topical application to the eye, the levels of fluorescein in breast milk are small and hence the amounts ingested by the infant would not be expected to cause any adverse effects. Therefore no special precautions are required (LactMed).

Due to the photosensitivity of fluorescein, there is a risk of phototoxicity, especially in neonates, but this is unlikely to be a problem within the normal therapeutic dose range. However, it may be advisable to temporarily avoid breastfeeding to allow the fluorescein to clear from the milk, or to avoid phototherapy in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic conjunctivitis
Allergic reaction
Anaphylactic reaction
Blurred vision (transient)
Periorbital oedema
Rash
Urticaria

Presentation

Eye drops (preservative free) and paper strips containing fluorescein sodium

Drugs List

Therapeutic Indications

Uses

Foreign bodies in the eye - detection of
Ophthalmic lesions - detection of
Tonometry - measurement of intraocular pressure

Dosage

Adults

Elderly

Children

Contraindications

Soft contact lenses

Precautions and Warnings

Breastfeeding
Pregnancy

Advise patient blurred vision may affect ability to drive/operate machinery
For single use only
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Advise patient to avoid touching the eye/other surfaces with container tip

Pregnancy and Lactation

Pregnancy

Case studies of fluorescein in pregnant women have not revealed any unwanted foetal effects. Fluorescein crosses the placenta; passage to the foetus due to systemic circulation should be expected, but is unlikely to produce unwanted effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Following topical application to the eye, the levels of fluorescein in breast milk are small and hence the amounts ingested by the infant would not be expected to cause any adverse effects. Therefore no special precautions are required (LactMed).

Due to the photosensitivity of fluorescein, there is a risk of phototoxicity, especially in neonates, but this is unlikely to be a problem within the normal therapeutic dose range. However, it may be advisable to temporarily avoid breastfeeding to allow the fluorescein to clear from the milk, or to avoid phototherapy in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic conjunctivitis
Allergic reaction
Anaphylactic reaction
Blurred vision (transient)
Periorbital oedema
Rash
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: November 2013

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary. 66th ed. London: BMJ Group and Pharmaceutical Press; 2013.

Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

Paediatric Formulary Committee. BNF for Children 2013-2014. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2013.

Summary of Product Characteristics: Fluorets. Bausch & Lomb U.K. Limited. Revised June 2007.

Summary of Product Characteristics: Minims Fluorescein Sodium. Bausch & Lomb U.K. Limited. Revised June 2007.

Summary of Product Characteristics: Minims Fluorescein Sodium 1%. Bausch & Lomb U.K. Limited. Revised June 2007.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
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