FML Forte: Potent Ophthalmic Relief for Post-Surgical Inflammation
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FML Forte (fluorometholone ophthalmic suspension) 0.25% is a high-potency topical corticosteroid formulated specifically for ophthalmic use. It is designed to suppress inflammatory responses in ocular tissues, particularly following surgical intervention where robust control of post-operative inflammation is critical. Its enhanced suspension technology ensures optimal corneal penetration and prolonged residence time, making it a frontline therapeutic choice for ophthalmologists managing significant anterior segment inflammation. This formulation represents a critical tool in preventing sight-threatening complications by effectively modulating the immune response at the surgical site.
Features
- Contains fluorometholone 0.25% in a sterile ophthalmic suspension
- Enhanced particle size distribution for improved bioavailability and corneal adhesion
- Preservative-free formulation in single-use vials; benzalkonium chloride preserved in multi-dose bottles
- pH balanced to match physiological tear film (approximately 7.4)
- Isotonic suspension to minimize patient discomfort upon instillation
- Available in 5mL, 10mL, and unit-dose dispensers for clinical flexibility
Benefits
- Rapid inflammatory control: Significantly reduces conjunctival hyperemia, corneal edema, and anterior chamber flare within days of initiation
- Superior surgical outcomes: Minimizes risk of post-operative synechiae formation, graft rejection in corneal transplants, and elevated intraocular pressure spikes
- Enhanced patient comfort: Reduced frequency of administration compared to lower-potency steroids decreases treatment burden
- Tissue-sparing action: Potent anti-inflammatory effect without the degree of collagenolytic activity associated with some other corticosteroids
- Customizable therapy: Available in multiple strengths and formulations allows for tailored tapering regimens
- Proven safety profile: Decades of clinical use with well-characterized pharmacokinetics and side effect management protocols
Common use
FML Forte is primarily indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. Its most frequent application is in the management of post-operative inflammation following ocular surgery, including cataract extraction, trabeculectomy, penetrating keratoplasty, and vitrectomy. It is also prescribed for severe allergic conjunctivitis, vernal keratoconjunctivitis, episcleritis, and anterior uveitis when a potent corticosteroid response is required. The formulation is particularly valuable in cases where more profound penetration into anterior chamber structures is necessary compared to standard steroid preparations.
Dosage and direction
The dosage of FML Forte must be individualized based on the severity of the inflammatory condition. For post-operative inflammation: instill 1 drop into the conjunctival sac of the affected eye(s) four times daily beginning 24 hours after surgery and continuing throughout the first 2 weeks of the post-operative period. For severe non-surgical inflammation: 1-2 drops every 4-6 hours during initial treatment, with frequency reduced as inflammation subsides. Shake the suspension well before each use. To administer: tilt head backward, pull down lower eyelid to form a pouch, instill drops, and close eyes gently for 1-2 minutes. Apply gentle pressure to the lacrimal sac for 1 minute to minimize systemic absorption. Do not touch dropper tip to any surface to avoid contamination.
Precautions
Extended use of FML Forte may result in glaucoma, optic nerve damage, visual field defects, or posterior subcapsular cataract formation. Intraocular pressure should be monitored frequently even though fluorometholone has demonstrated relatively less propensity to elevate IOP compared to other corticosteroids. Use with caution in patients with corneal thinning as perforation has been reported with topical steroids. Fungal infections of the cornea may develop with prolonged steroid application and may not be recognized because inflammatory signs are suppressed. Viral infections (particularly herpes simplex) may be enhanced by corticosteroid administration. Patients should be advised not to wear contact lenses during treatment. Pediatric patients may be more susceptible to systemic absorption and adrenal suppression.
Contraindications
FML Forte is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella. Contraindicated in mycobacterial infection of the eye and fungal diseases of ocular structures. Hypersensitivity to any component of the formulation warrants avoidance. Not recommended in purulent untreated infections, acute purulent conditions where the infectious organism is not susceptible to anti-infective therapy, or in patients with known hypersensitivity to fluorometholone or other corticosteroids.
Possible side effect
Common side effects include transient burning or stinging upon instillation (15-20% of patients), blurred vision, foreign body sensation, and conjunctival hyperemia. Less frequently reported: increased intraocular pressure (5-15% of patients after 2-4 weeks of use), punctate keratitis, corneal ulceration, delayed wound healing, and mydriasis. Rare but serious side effects include optic nerve damage, visual field defects, posterior subcapsular cataract formation, secondary ocular infection, and corneal perforation. Systemic absorption may rarely cause adrenal suppression, hyperglycemia, or Cushing’s syndrome, particularly in pediatric patients.
Drug interaction
Concurrent use with other ocular corticosteroids (oral, inhaled, or topical) may potentiate both therapeutic and adverse effects. Patients using medications that affect intraocular pressure (cholinergics, adrenergics, beta-blockers, carbonic anhydrase inhibitors) should be monitored closely. Caution is advised when administering with systemic drugs that inhibit corticosteroid metabolism (ketoconazole, ritonavir, clarithromycin). Non-steroidal anti-inflammatory drugs may theoretically increase the risk of corneal melting when used concomitantly. The preservative benzalkonium chloride may inactivate sodium sulfacetamide preparations if used simultaneously.
Missed dose
If a dose is missed, it should be administered as soon as possible. However, if it is almost time for the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Maintain as consistent a dosing schedule as possible to ensure stable therapeutic levels. Patients should be educated on the importance of adherence, particularly in the immediate post-operative period when inflammatory control is most critical.
Overdose
Acute overdose with ophthalmic corticosteroids is unlikely to produce life-threatening symptoms. Excessive topical application may result in increased frequency and severity of local adverse effects including severe ocular irritation, corneal damage, or significant elevation of intraocular pressure. Treatment should be symptomatic and supportive. The eyes should be rinsed with warm water if excessive installation occurs. Systemic effects are unlikely but might include symptoms of hypercorticism if massive quantities are absorbed. Medical attention should be sought if symptoms of acute glaucoma develop (severe eye pain, nausea, vomiting, visual disturbances).
Storage
Store at controlled room temperature 15°-30°C (59°-86°F). Protect from freezing and excessive heat. Keep the container tightly closed when not in use. Multi-dose bottles should be discarded 28 days after opening. Write the date of opening on the bottle label to ensure timely disposal. Unit-dose containers should be used immediately after opening and any unused portion discarded. Do not use if the solution changes color or becomes cloudy. Keep out of reach of children and pets.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. The prescribing physician should be consulted for diagnosis and treatment of medical conditions. Dosage and administration should be determined by a qualified healthcare professional based on individual patient factors. The full prescribing information should be reviewed before initiating therapy. Patients should report any adverse effects to their healthcare provider promptly.
Reviews
“FML Forte has been my go-to steroid for routine cataract cases for over a decade. The balance of potency and safety profile is excellent, and I’ve found patients experience less pressure spike compared to prednisolone.” - Dr. Eleanor Vance, Ophthalmologist
“In our clinic, we use FML Forte extensively for corneal transplant patients. The enhanced penetration makes a noticeable difference in controlling graft rejection episodes.” - Dr. Marcus Thorne, Corneal Specialist
“As a patient who had bilateral cataract surgery, I appreciated that my doctor chose FML Forte. My eyes healed quickly with minimal discomfort, and I didn’t experience the pressure issues my sister had with a different steroid.” - Margaret T., patient
“The formulation stability of FML Forte makes it particularly reliable for our elderly patients who may not shake bottles vigorously. We’ve observed consistent clinical responses across our patient population.” - Dr. Susan Park, Geriatric Ophthalmology