Phototoxicity from systemic sodium fluorescein

Purpose: To confirm the occurrence of phototoxicity due to systemic fluorescein in a dose consistent with retinal angiographic testing and to approximate the prevalence of this reaction in a small group of volunteers. Methods: Fourteen volunteers underwent a controlled challenge test by applying a topical sunscreen and exposing skin areas to direct sunlight before and after fluorescein administration. Results: Two subjects experienced marked cutaneous blanching erythema, mild vesiculation, and pain in sun-exposed areas within 1 hour of exposure, The reaction faded over a period of days without tanning, Conclusions: Consistent with its in vitro properties as a photodynamic dye, fluorescein may rarely act as a phototoxic agent in humans at doses employed for fluorescein retinal angiography. It is unclear why this reaction has not been reported more frequently, given the large number of patients undergoing this ophthalmic procedure annually.