Ophthalmic procedures requiring a disclosing agent with topical anesthesia
1 to 2 drops in the eye as needed to achieve adequate anesthesia; extend by repeat instillation 10 to 20 minutes after the last dose
Maximal corneal anesthesia in 5 to 45 seconds, lasting about 20 minutes after a single instillation.
Contraindications
Known hypersensitivity to any component of this product.
Available Forms
Fluorescein sodium 0.25% (2.5 mg/mL) with benoxinate HCl 0.4% (4 mg/mL) ophthalmic solution, 5 mL glass bottle with sterilized dropper
Mechanism of Action
Combination of a disclosing dye with a rapidly acting ester anesthetic of short duration: fluorescein is excluded by an intact epithelial barrier and fluoresces green under cobalt blue excitation, while benoxinate blocks sodium channel conduction in corneal and conjunctival sensory nerve endings. Maximal corneal anesthesia occurs in about 5 to 45 seconds and lasts about 20 minutes after a single instillation.
Warnings & Precautions
Corneal toxicity: Prolonged use or abuse may cause epithelial toxicity, manifesting as epithelial defects that can progress to permanent corneal opacification with visual loss.
Corneal injury from insensitivity: The eye stays insensate for about 20 minutes after instillation; keep the patient from touching or rubbing it during that window, as accidental injury will not be felt.
Anesthetic abuse keratopathy: Case reports of self-administered oxybuprocaine (benoxinate) describe persistent epithelial defects, stromal infiltration and thinning, descemetocele, endothelial ultrastructural damage, and penetrating keratoplasty, at concentrations as low as 0.05%.
Solution contamination: Fluorescein supports bacterial growth; 21 of 21 in-use clinic bottles of plain fluorescein solution cultured positive, most often Pseudomonas spp., while unopened bottles were sterile. Chlorobutanol-preserved fluorescein with benoxinate self-sterilizes rapidly, clearing Pseudomonas within 15 seconds in vitro; of four commercial fluorescein-anesthetic preparations inoculated, that formulation was the one that regained sterility, while the other three still grew organisms 1 hour later.
Soft contact lens staining: Dye is absorbed into the hydrogel matrix in proportion to exposure time and varies with lens power and water content, so soft lenses come out first; rinse with 0.9% saline rather than an oxidizing agent, since 3% hydrogen peroxide decolorizes retained dye without removing it.
Storage: Refrigerate at 2 to 8 degrees C; after opening, up to 1 month at room temperature or until the labeled expiration date if kept refrigerated.
Common Side Effects
Ocular, most common: Stinging, burning, and conjunctival redness.
Ocular, postmarketing: Ocular hyperemia, eye irritation, blurred vision, and punctate keratitis; reported voluntarily from a population of uncertain size, so frequency cannot be estimated.
Pregnancy & Lactation
Pregnancy: No data in pregnant women, and adequate animal reproduction studies have not been conducted for either component; give only if clearly needed.
Lactation: No data on presence in human milk, on the breastfed infant, or on milk production.
Pediatric Use
Established in pediatric patients, supported by evidence from adequate and well controlled studies.
GoodRx
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use