Appendix
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Ophthalmology

Fluorescein Angiography

Fundus fluorescein angiography (FFA) is an invasive diagnostic procedure. It helps to assess the anatomy, physiology, and pathology of retinal and choroidal circulation. It aids in the diagnosis of various ocular pathologies. It contributes to decision-making when planning the management of ocular pathology. It is also useful as a teaching tool. Although it is a safe procedure, there are adverse effects associated with it. This activity outlines the basic principles, techniques, and interpretati

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Severe allergic reactions like bronchospasm, laryngeal edema, and acute myocardial infarction are life-threatening and need urgent care.
  • A few cases of death have been documented with intravenous administration of fluorescein.
  • The healthcare team should be alert to notice early signs of syncope or anaphylaxis in the patient.
  • Fundus fluorescein angiography (FFA) is an invasive diagnostic procedure.
  • It aids in the diagnosis of various ocular pathologies.
  • Interpretation and understanding of FFA help in the accurate diagnosis and evaluation of various pathologies.
  • To rule out macular ischemia in cases of diabetic retinopathy with unexplained poor vision.
  • To classify ischemic and nonischemic central retinal vein occlusion (CRVO).
  • To identify and document the activity of choroidal neovascular membrane (CNVM) in various retinal diseases, including age-related macular degeneration (AMD), pigment epithelium detachment (PED), choroidal rupture, RPE rip, angioid streaks, serpiginous choroiditis, presumed ocular histoplasmosis syndrome, Best vitelliform macular dystrophy, choroidal osteoma, healed choroidal tuberculoma, and others.
  • To confirm the diagnosis of ocular ischemic syndrome in cases with neovascularization of the iris, venous dilatation, and mid-peripheral retinal hemorrhages.
  • To identify the type of leak in cases of central serous chorioretinopathy (CSCR).
  • The pupil should be well dilated before starting the procedure.
  • The patient should be primed about the risk of nausea so that initial images are properly acquired.
  • The scalp vein set is to be placed in the patient's arm, and some blood is drawn into the tubing to confirm the position of the needle.
  • When initiating the injection of dye, any extravasation of the dye should be carefully monitored.
  • The healthcare team should be alert to notice early signs of syncope or anaphylaxis in the patient.
  • It is better to reassure the patient throughout the procedure and keep them informed about its progress.
Sodium fluorescein
intravenously
Adult
500 mg
Renal
Not specified in source
Duration
Not specified in source
Sodium fluorescein
intravenously
Adult
7.7 mg/kg
Renal
Not specified in source
Duration
up to a maximum dose of 500 mg
Sodium fluorescein
intravenously
Adult
0.04 mL/kg (8 mg/kg)
Renal
Not specified in source
Duration
followed by a saline flush
oral promethazine hydrochloride
oral
Adult
25 to 50 mg
Renal
Not specified in source
Duration
one hour before the procedure
  • Fluorescein angiography is relatively contraindicated in pregnancy.
  • A history of severe allergic reactions is an absolute contraindication for fluorescein administration.
  • In patients with a history of moderate allergic reactions to fluorescein, pretreatment with an antihistaminic agent or corticosteroid can be done.
  • A history of cardiovascular or renal disease is not a contraindication for FFA.
  • ICGA is a better investigation tool for imaging occult CNVM as the visibility of the CNVM network is better than on FFA.
  • Oral FFA can be done after off-label oral administration of sodium fluorescein.
  • Extravasation of the dye under the skin is a severe side effect and should be avoided.
  • Nausea is the most frequent side effect (0.06 to 15.29 %).
  • Vomiting does not occur frequently.
  • Vasovagal syncope occurs in apprehensive patients.
  • A more severe reaction in the form of bradycardia and hypotension may occur.
  • The most frequent allergic reactions are mild. This includes hives or itching.
  • Severe allergic reactions like bronchospasm, laryngeal edema, and acute myocardial infarction are life-threatening and need urgent care.
  • The overall incidence of death has been reported as 1 in 2,22,000.
  • review
    Fluorescein Angiography. StatPearls [Internet] — Surabhi Ruia, Koushik Tripathy — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov