Side Effects Following Fluorescein Examination
After a fluorescein examination, patients should be informed that they may experience temporary discoloration of bodily fluids, including yellow-orange urine, but should not expect diarrhea, orange colored stool, or colored nasal drainage as these are not documented side effects of fluorescein dye used in ophthalmic examinations.
Understanding Fluorescein Use in Ophthalmic Examinations
Fluorescein is commonly used in ophthalmology for various diagnostic procedures, including:
- Tear break-up time testing to evaluate tear film stability
- Ocular surface staining to assess epithelial integrity
- Fluorescein angiography to evaluate retinal vasculature
Fluorescein Administration Methods
Fluorescein is administered in different ways depending on the examination:
- Topical application: Using moistened fluorescein strips or drops applied to the ocular surface for tear film and corneal/conjunctival assessment 1
- Intravenous injection: For fluorescein angiography to visualize retinal vasculature 1
- Oral administration: Less commonly used alternative for angiography 2
Expected Side Effects After Fluorescein Use
Common and Expected Effects
- Yellow discoloration of urine: This is the primary expected side effect as fluorescein is primarily excreted through the kidneys 3, 4
- Temporary yellow skin discoloration: May occur with higher doses 3
Uncommon Side Effects
- Nausea/vomiting: Occurs in approximately 1.4% of patients undergoing fluorescein angiography 4
- Transient hypotension: Rare but documented 4
- Skin reactions: Including injection site erythema or diffuse rash 4
Serious but Very Rare Side Effects
- Anaphylaxis: Estimated incidence of 0.3% with intravenous administration 5
- Severe allergic reactions: Extremely rare but potentially life-threatening 5
What Patients Should NOT Expect
It's important to note that the following are NOT documented side effects of fluorescein used in ophthalmic examinations:
- Diarrhea: Not reported in the literature as a side effect
- Orange colored stool: Not documented in clinical guidelines or research
- Colored oral secretions: Not an expected outcome
- Colored nasal drainage: Not mentioned in any of the clinical guidelines
Special Considerations
Pediatric Patients
Extra caution should be used in pediatric patients, as overdosage can lead to more pronounced yellowing of skin and bodily fluids, though without serious consequences in documented cases 3.
Pregnant Patients
Fluorescein crosses the placenta, but detrimental effects on the fetus have not been documented 1.
Patient Education and Follow-up
When counseling patients after a fluorescein examination:
- Inform them about expected yellow discoloration of urine that will resolve within 24-48 hours
- Reassure them that this discoloration is harmless and temporary
- Advise them to report any unexpected symptoms like rash, difficulty breathing, or significant discomfort
- Explain that diarrhea, colored stool, oral secretions, or nasal drainage are not expected and should be reported if they occur
By providing accurate information about expected side effects, clinicians can help reduce unnecessary patient concern while ensuring appropriate monitoring for the rare but serious adverse reactions that can occur with fluorescein use.