FML Forte (Fluorometholone 0.25%)

Prolonged use: Raises IOP in susceptible individuals, producing glaucoma with optic nerve damage, defects in visual acuity and fields, and posterior subcapsular cataract; it also suppresses host immune response and increases the hazard of secondary ocular infection.

Steroid IOP response: Average time to a rise is significantly longer than with dexamethasone phosphate, but a small percentage of individuals rise significantly within one week and the ultimate magnitude of the rise is equivalent for both drugs.

IOP monitoring: Monitor routinely if the product is used 10 days or longer, including in children and uncooperative patients, and use with caution in existing glaucoma.

Corneal or scleral thinning: Long-term topical steroid use and various ocular diseases thin these tissues, and use over thin cornea or sclera may lead to perforation.

Acute purulent infection: May be masked or its activity enhanced by corticosteroid.

Post-cataract surgery use: May delay healing and increase the incidence of bleb formation.

Viral ocular infection: Course may be prolonged and severity worsened, including herpes simplex; a history of herpes simplex demands great caution and frequent slit lamp microscopy.

Fungal keratitis: Particularly prone to develop with long-term local corticosteroid use; suspect fungal invasion in any persistent corneal ulceration and take cultures where appropriate.

Soft contact lenses: Benzalkonium chloride 0.005% may be absorbed; wait at least 15 minutes after instillation before inserting lenses.

Renewal beyond 20 mL: Initial prescription and renewal past that volume warrant examination with magnification such as slit lamp biomicroscopy and, where appropriate, fluorescein staining.