Ophthalmic procedures requiring a disclosing agent with topical anesthesia
1 to 2 drops in each eye as single instillations before foreign body or suture removal and before tonometry; for deep ophthalmic anesthesia, 1 drop in each eye every 5 to 10 minutes for 5 to 7 doses
Its proparacaine component numbs the cornea within 1 minute, with sensitivity back by 45 minutes.
Contraindications
Known hypersensitivity to any component of this product.
Available Forms
Fluorescein sodium 0.25% (2.5 mg/mL) with proparacaine HCl 0.5% (5 mg/mL) ophthalmic solution, 5 mL fill in a glass bottle with a controlled tip dropper
Mechanism of Action
Combination of a disclosing dye with a rapidly acting anesthetic of short duration. Fluorescein 0.25% is excluded by intact corneal epithelium and pools where the barrier is broken, fluorescing yellow-green under cobalt blue light, while proparacaine 0.5%, an ester anesthetic, blocks sodium channel conduction in corneal and conjunctival sensory nerve endings.
Warnings & Precautions
Corneal opacification from prolonged use: Prolonged use of a topical ocular anesthetic is not recommended and may produce permanent corneal opacification with visual loss.
Delayed wound healing: Long-term toxicity is unknown and prolonged use may delay wound healing; in cultured human corneal fibroblasts and in rabbits, 0.5% and 0.05% proparacaine twice daily for 3 days both impeded the corneal wound healing response in a time-dependent manner, adding polymyxin B and trimethoprim had additive effects on fibroblast viability, proliferation, and migration and on epithelial recovery, and 0.05% alone had minimal negative effect.
Systemic toxicity: Exceedingly rare with ophthalmic application of local anesthetics, but central nervous system stimulation followed by depression can occur.
Allergy, cardiac disease, hyperthyroidism: Use cautiously and sparingly in these patients.
Corneal protection during anesthesia: Protect the eye from irritating chemicals, foreign bodies, and rubbing until sensation returns, and keep the patient from touching the eye.
Tonometer rinsing: Tonometers soaked in sterilizing or detergent solutions must be rinsed thoroughly with sterile distilled water before use.
Dropper contamination: Do not touch the sterile dropper tip to any surface, and replace the container closure immediately after use.
Contamination of combination solutions: Of four commercial fluorescein-anesthetic solutions inoculated with Pseudomonas or Staphylococcus, only Fluress regained sterility (1 minute for the solution, 5 minutes for the dropper tip), while the other three, which were not individually named, still yielded organisms at least 1 hour after inoculation; separately, reuse of unpreserved single-application fluorescein 0.25% with proxymetacaine 0.5% Minims across consecutive patients grew lid and conjunctival flora from 7 of 41 vials (17%).
Storage: Refrigerate at 2 to 8 degrees C, with up to 1 month at room temperature.
Common Side Effects
Ocular, occasional: Temporary stinging, burning, and conjunctival redness, reported after use of ocular anesthetics.
Ocular, rare: Severe immediate-type hyper-allergic corneal reaction with acute, intense, diffuse epithelial keratitis, a gray ground glass appearance, sloughing of large areas of necrotic epithelium, corneal filaments, and sometimes iritis with descemetitis.
Dermatologic: Allergic contact dermatitis with drying and fissuring of the fingertips.
Pregnancy & Lactation
Limited data; potential risks to the fetus not well established
GoodRx
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use