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9 of 216 medications
Brilliant Blue G 0.025%
TissueBlue®Diagnostic Dye
GoodRxApproved uses
Staining of the internal limiting membrane during vitreoretinal surgery
Injected into the BSS-filled vitreous cavity through a blunt cannula; staining takes a few seconds, then all excess dye is removed
Stains the ILM but not the epiretinal membrane or retina, which is what makes the peel possible
Contraindications
None.
Available Forms0.5 mL of Brilliant Blue G ophthalmic solution 0.025% in a sterile pre-filled syringe.
Mechanism of ActionBrilliant Blue G has been shown to selectively stain the ILM, but not the epiretinal membrane nor the retina, making it easier to visualize the membrane for removal, although the exact mechanism of this selectivity has not been elucidated.
Warnings & Precautions
- Excessive staining: remove excess dye from the eye immediately after staining.
- Check that the syringe plunger moves smoothly before injecting; do not use the product if it does not.
- Do not allow the cannula to contact the retina, and do not allow the dye to pass under the retina.
Common Side Effects
Adverse reactions that have been reported in procedures that included the use of Brilliant Blue G Ophthalmic Solution have often been associated with the surgical procedure. These complications include retinal (retinal break, tear, hemorrhage, and detachment) and cataracts. Adverse reactions that have been reported in procedures that included the use of TissueBlue 0.025% have often been associated with the surgical procedure.
Pregnancy & LactationPregnancy: No available data on use in pregnant women; systemic absorption is expected to be negligible.
Lactation: No data; systemic absorption is expected to be negligible.
Pediatric UseThe safety and effectiveness of TissueBlue 0.025% in pediatric patients has not been established.
Fluorescein
Bio-Glo® · Fluorescite®Diagnostic DyeInjections & Implants
GoodRxApproved uses
Anterior segment staining (contact lens fitting, disclosing corneal injury, applanation tonometry)
One strip moistened with 1 or 2 drops of sterile irrigating or saline solution, touched to the conjunctiva or fornix, followed by several blinks
OFF-LABELNot in the FDA label for this product
Tear breakup time for dry eye
One saline-moistened strip touched to the conjunctiva or fornix, then time the first break in the tear film; hold the moistening solution and volume constant and average several readings
Diagnostic · n=46 · technique
In a randomized comparison of three instillation methods in 46 subjects, a standard moistened strip gave an area under the curve of 0.912 with a 3.42 second cut-point (sensitivity 0.97, specificity 0.80) and differed little from micropipetted dye, though the authors put the optimum cut-point at 5.3 to 6.0 seconds when measured liquid volumes were used. Technique moves the number: strips deliver less than 1 microliter with a wider range than a pipette, raising instilled volume from 1 to 2.7 microliters lengthens the measured time (P<0.001), and six common moistening solutions gave significantly different values in 58 subjects, only the two saline solutions being indistinguishable from each other.
Fluorescein dye disappearance test for lacrimal outflow obstruction
One drop of fluorescein solution to the inferior fornix of each eye, residual tear film dye graded at 5 minutes
Diagnostic · n=80 · not strip
Prospective evaluation of lacrimal outflow obstruction in infants: 90% sensitive and 100% specific across 80 lacrimal systems in the preliminary study, and abnormal in 237 of 288 eyes of children presenting with epiphora in the main study. A retrospective series of 176 eyes after dacryocystorhinostomy found the 5 minute test 100% sensitive and 86.3% specific in assessing anatomical success, every anatomically failed case showing a positive test; both series instilled dye solution rather than a strip.
Contraindications
- The labeling for this unapproved drug states no condition under which the strips must not be used
- It states only that they are for external use only and that contents may not be sterile if individual strips have been damaged or previously opened
Available FormsFluorescein sodium impregnated paper strips, dispenser carton of 100 or 300 strips
Mechanism of ActionWater soluble dye that is excluded by an intact epithelial barrier and fluoresces green under cobalt blue excitation, disclosing epithelial defects and outlining the tear film. Impression cytology and confocal microscopy trace punctate staining to individual superficial epithelial cells with enhanced fluorescence rather than to dye pooling in erosions alone.
Warnings & Precautions
- Solution contamination: Fluorescein supports bacterial growth. All 21 in-use multiple-use bottles of fluorescein solution sampled from eye clinics grew organisms, most often Pseudomonas spp., while 18 unopened bottles were sterile; a strip removes that reservoir and leaves the moistening solution and the strip tip as the points of contact.
- 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 before instillation; rinse with 0.9% saline rather than an oxidizing agent, since 3% hydrogen peroxide decolorizes retained dye without removing it.
Common Side Effects
The labeling for this unapproved drug has no adverse effects section, so it reports no side effects for the strips.
Pregnancy & LactationLimited data; potential risks to the fetus not well established
Pediatric UseAll ages
Fluorescein 0.25% / Benoxinate 0.4%
Altafluor®Diagnostic DyeLocal Anesthetic
GoodRxApproved uses
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 FormsFluorescein 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 ActionCombination 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 & LactationPregnancy: 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 UseEstablished in pediatric patients, supported by evidence from adequate and well controlled studies.
Fluorescein 0.25% / Proparacaine 0.5%
Fluoracaine®Diagnostic DyeLocal Anesthetic
GoodRxApproved uses
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 FormsFluorescein 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 ActionCombination 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 & LactationLimited data; potential risks to the fetus not well established
Pediatric UseAll ages
Indocyanine Green
Indocyanine GreenDiagnostic DyeInjections & Implants
GoodRxApproved uses
Ophthalmic angiography of the choroidal vasculature
Up to 40 mg in 2 mL of Sterile Water for Injection as an antecubital vein bolus, followed immediately by a 5 mL bolus of normal saline
OFF-LABELNot in the FDA label for this product
Internal limiting membrane staining during macular hole surgery
0.05% (0.5 mg/mL) applied intraocularly over the macula to stain the membrane before peeling, an intraocular rather than intravenous route
Meta-analysis · 12/17 retro
A network meta-analysis of 17 studies (12 retrospective, 5 randomized) in 1492 patients with stage II to IV idiopathic macular hole found that peeling with 0.25% of this dye performed worse for hole closure than peeling with no dye at all, while 0.05% brilliant blue G, 0.15% trypan blue, 0.5% and 0.05% of this dye all outperformed 0.25%; the authors suggest 0.05% as a good choice for surgeons who prefer this dye, and call for large high-quality randomized trials to confirm the ranking. A separate meta-analysis of 9 studies and 846 eyes found better postoperative acuity with brilliant blue G than with this dye (mean difference -0.10 logMAR, 95% CI -0.16 to -0.03, P=0.004, negative favoring brilliant blue G) but no significant difference in closure rate (OR 1.98, 95% CI 0.71 to 5.48, P=0.19).
Contraindications
History of allergy to iodides; the product contains sodium iodide and the label directs caution rather than avoidance.
Available Forms25 mg lyophilized powder in a 30 mL vial, supplied as a kit of six 25 mg vials with six 10 mL Sterile Water for Injection vials
Mechanism of ActionWater-soluble tricarbocyanine dye with peak spectral absorption near 800 nm, a region where the pigment epithelium transmits energy more efficiently than visible light, so the choroidal circulation can be imaged through it. Nearly 98% bound to blood protein, so it does not extravasate appreciably from the highly fenestrated choroidal vasculature, and it is taken up almost exclusively by hepatic parenchymal cells and secreted entirely into bile.
Warnings & Precautions
- Anaphylactic deaths: Reported following administration during cardiac catheterization; the label's stated treatment for an anaphylactic or urticarial reaction is epinephrine, antihistamines, and corticosteroids.
- Solution instability: Unstable in aqueous solution, so use within 6 hours of reconstitution and discard if a precipitate is present; the dye is stable in plasma and whole blood, so drawn samples can be read hours later.
- Radioactive iodine uptake studies: Do not perform for at least 1 week after administration.
- Heparin containing sodium bisulfite: Reduces the absorption peak in blood, so it should not be used as the anticoagulant when collecting samples for analysis.
Common Side Effects
- Hypersensitivity: Anaphylactic or urticarial reactions have been reported in patients with or without a history of allergy to iodides.
- Reaction frequency: Across 1923 ophthalmic videoangiograms in 1226 consecutive patients there were 3 mild (0.15%), 4 moderate (0.2%), and 1 severe (0.05%) reaction and no deaths; a 15-institution Japanese survey of 3774 angiograms recorded 13 reactions (0.34%), 10 of them mild, with 2 patients treated for shock and 1 injection-site vein pain requiring treatment.
Pregnancy & LactationPregnancy: Category C, with no animal reproduction studies conducted and no data on whether it causes fetal harm or affects reproductive capacity; give only if clearly indicated.
Lactation: Excretion in human milk is unknown, and the label advises caution in a nursing woman.
Pediatric UseSafety and effectiveness in pediatric patients have been established.
Lissamine Green
Lissamine GreenDiagnostic Dye
GoodRxApproved uses
Ocular surface staining for suspected corneal or conjunctival epithelial damage
One strip moistened with 1 to 2 drops of sterile saline or irrigating solution, touched to the conjunctiva or fornix, followed by several blinks
1% solution stains as well as rose bengal with less discomfort, and is best graded within 4 minutes.
Contraindications
- Not to be used with soft contact lenses
- The labeling for this unapproved drug gives no other condition under which the strips must not be used
Available FormsDye-impregnated strips, dispenser carton of 100.
Mechanism of ActionOrganic vital dye that healthy epithelium excludes; uptake marks cells whose membranes are damaged, and exposed corneal stroma also stains. In vitro, chemically permeabilized cells show nuclear staining, while trypsin pretreatment does not induce uptake.
Warnings & Precautions
- Strip dye concentration: A single wetted strip measures about 0.17%, roughly five-fold below the 1% used for vital staining; 2 strips in 200 microliters for 5 minutes reach 1%.
- In vitro antiviral activity: 0.06% dye reduced HSV-1 plaque formation by more than 50% in cell culture; in a rabbit herpetic keratitis model it did not affect viral replication or recovery, so an effect on clinical viral culture is unproven.
Common Side Effects
- Ocular: Transient stinging on instillation of 1% solution, milder and shorter-lived than with 1% rose bengal (mean sensation 2.4 of 5 versus 4.6 in 12 keratoconjunctivitis sicca patients).
- Ocular, above 1%: Burning and discomfort with 2% and 3% solutions; a 2% fluorescein plus 1% dye mixture caused none.
- Adnexal: A 20 microliter instillation overflowed and stained lid and facial skin.
Pregnancy & LactationLimited data; potential risks to the fetus not well established
Pediatric UseAll ages
Methylene Blue
Methylene BlueDiagnostic Dye
GoodRxApproved uses
Drug-induced methemoglobinemia (systemic, not an ocular use)
0.1 to 0.2 mL/kg of the 1% solution IV, injected very slowly over several minutes
Contraindications
- Pregnancy or possible pregnancy; teratogen, with ileal and jejunal atresia and ileal occlusion reported after use in amniocentesis
- Intraspinal or subcutaneous injection
- Known hypersensitivity to methylene blue
Available Forms1% injection (10 mg/mL), 2 mL single-dose prefilled syringes, cartons of five.
Mechanism of ActionLow concentrations reduce methemoglobin back to hemoglobin, while high concentrations oxidize ferrous iron to ferric and generate methemoglobin; metabolism is to leukomethylene blue, excreted mainly in urine. It is also a potent monoamine oxidase inhibitor, which is the basis of the serotonin toxicity risk.
Warnings & Precautions
- Serotonin syndrome: Boxed warning. Serious or fatal serotonergic reaction with SSRIs, SNRIs, or monoamine oxidase inhibitors; avoid concomitant use.
- Serotonergic drug interactions: Tricyclics, norepinephrine-dopamine reuptake inhibitors, triptans, and ergot alkaloids carry the same risk of fatal serotonin toxicity; any serotonin reuptake inhibitor must be stopped before treatment.
- G6PD deficiency: Paradoxical methemoglobinemia and hemolysis; avoid.
- Rapid injection: Local high concentration produces additional methemoglobin, so the dose is given over several minutes.
- Severe renal impairment: Caution advised.
Common Side Effects
- Systemic, large IV doses: Nausea, abdominal and precordial pain, dizziness, headache, profuse sweating, mental confusion, and methemoglobin formation.
- Serotonin toxicity: Tremor, clonus, myoclonus, hyperreflexia, and pyramidal rigidity when advanced; diaphoresis, fever, tachycardia, tachypnea, mydriasis; agitation, excitement, and confusion.
Pregnancy & LactationPregnancy: Contraindicated. Category X teratogen; ileal and jejunal atresia and ileal occlusion reported in neonates after use in amniocentesis.
Lactation: Not addressed in this label.
Pediatric UseAll ages
Rose Bengal
Rose BengalDiagnostic Dye
GoodRxApproved uses
Ocular surface staining for suspected corneal or conjunctival tissue change
One strip moistened with 1 or 2 drops of sterile isotonic saline or irrigating solution, excess shaken off, touched to the conjunctiva or fornix, followed by several blinks
Contraindications
Known hypersensitivity to rose bengal.
Available FormsOphthalmic strips, 1.3 mg per strip, dispenser carton of 100
Mechanism of ActionThe label describes a vital stain that marks the nuclei and cell walls of dead or degenerated corneal and conjunctival epithelial cells and the mucus of the precorneal tear film. In vitro it also stains healthy cells, including rabbit corneal epithelium, rapidly, dose dependently and predominantly in the nucleus unless mucin or albumin blocks it, so staining indicates poor protection of the surface by the tear film rather than loss of cell vitality.
Warnings & Precautions
- Epithelial toxicity: Staining is not inert. Cultured cells including rabbit corneal epithelium lost vitality after exposure, with immediate morphologic change, loss of motility, detachment and cell death, and the effect was augmented by light exposure.
- Viral culture interference: Topical application reduced surface herpes simplex titers a million-fold in the mouse herpetic keratitis model, with a 50% inhibitory dose of 16 mcg/mL in vitro, so diagnostic use before viral culture may preclude a positive result; the same authors discourage using this dye to grade keratitis in antiviral trials. Fluorescein had no significant effect on viral replication.
- Package sterility: Contents may not be sterile if the individual strip package has been damaged or previously opened.
Common Side Effects
- Ocular: Stinging on instillation, more intense and longer lasting than with lissamine green; mean sensation on a 0 to 5 scale 4.6 versus 2.4 in 12 keratoconjunctivitis sicca patients and 2.5 versus 1.4 in 8 subjects with normal surfaces, both differences significant, using 1% solutions.
- Ocular, dye mixtures: Moderate to marked discomfort from a 2% fluorescein plus 1% dye mixture in 14 dry eye subjects, the most efficacious of the 16 solutions tested for combined corneal and conjunctival staining.
Pregnancy & LactationLimited data; potential risks to the fetus not well established
Pediatric UseAll ages