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11. Eye

Some brand names of eye drops have been included in brackets for information, but please always prescribe eye drops generically.

Note: The Northern (NHS) Treatment Advisory Group does not recommend the use of high-dose vitamin and mineral supplements in the prevention of progression of AMD.

Note: The Northern (NHS) Treatment Advisory Group recommends the sequential pharmacological management of MO secondary to RVO as per the North East Retina Group (NERG) RVO treatment pathway.

CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

NHS England Guidance on “Conditions for which over the counter items should not routinely be prescribed” available at: https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

Drug Name

Place in therapy

Brand name (where appropriate)

RAG

Classification

Details

Propamidine isetionate

First-line

Golden Eye

Brolene

Green

1.5mg per gram Eye OintmentOTC

1mg per mL Eye DropsOTC

Chloramphenicol

First-line

 

Green

5mg per mL  Eye Drops
10mg per mL Eye Ointment

Chloramphenicol preservative -free

First-line

 

Green

5mg per mL (0.5mL Unit dose) Eye Drops

Fusidic Acid

Second line

 

Green (Alternative)

10mg per gram Modified Release Eye Drops

 

Gentamicin

Second line

 

Green (Alternative)

3mg per mL Eye/Ear Drops

Gentamicin

Preservative - free

Second line

Minims

Green (Alternative)

3mg per mL  Minims Eye drops (Preservative-free)( UNLICENSED)

Ofloxacin

Second line

Exocin

Green (Alternative)

3mg per mL  Eye Drops

Gentamicin

Third line

 

Red

15mg per mL Eye Drops (UNLICENSED)

Erythromycin

Third line

 

Red

5mg per gram Eye Ointment (UNLICENSED)

Benzylpenicillin

Third line

 

Red

3mg per mL Eye Drops (UNLICENSED)

Cefuroxime

Third line

 

Red

50mg per mL Eye Drops (UNLICENSED)

Povidone Iodine

Third line

Minims

Red

50mg per mL preservative-free Minims Eye Drops

Povidone Iodine

Third line

kit

Red

50mg per mL Eye Drops (UNLICENSED) – do not contains Nonoxynol-9 and Alkyl Phenol which are

known severe eye irritants .

 Nonoxynol-9 is known to damage epithelial tissue. The European Chemical Agency states that Nonoxynol-9 causes serious eyedamage: http;//echa.europa.eu/substance-information/-/substanceinfo/100.043.454.

PolyHexaMethylene Biguanide (PHMB)

Third line

 

Red

0.2mg per mL Eye Drops

Known as” Polyhexanide” (UNLICENSED)

Propamidine isetionate
BNF | BNFC | SPC

1.5mg per gram Eye OintmentOTC

1mg per mL Eye DropsOTC

Approved for First-line use

Chloramphenicol
BNF | BNFC | SPC

Eye drops - 0.5%OTC

Ointment - 1%OTC

Preservative-free = 0.5% preservative-free Minims

Approved for first-line use.

Fusidic Acid
BNF | BNFC | SPC

MR Eye Drops - 1% (Fucithalmic)

Approved for second line use.

Gentamicin
BNF | BNFC | SPC

Eye drops - 0.3%

3mg per mL Minims Eye drops (Preservative-free)( UNLICENSED)

Approved for second line use.

Ofloxacin
BNF | BNFC | SPC

0.3% eye drops

Approved for second line use.

Gentamicin 15mg/ml
BNF | BNFC | SPC

15mg/ml eye drops (unlicensed)

Approved for third line use.

Erythromycin
BNF | BNFC | SPC

0.5% eye ointmentu

Approved for third line use.

Benzylpenicillin
BNF | BNFC | SPC

0.3% eye dropsu

Approved for third line use.

Cefuroxime
BNF | BNFC | SPC

5% eye dropsu

Approved for third line use.

Povidone Iodine
BNF | BNFC | SPC

5% Minims preservative-free eye dropsu

Povidone Iodine kit 50mg per mL Eye Drops (UNLICENSED) – do not contains Nonoxynol-9 and Alkyl Phenol which are
known severe eye irritants .

Approved for third line use.

Polyhexamethylene biguinide
BNF | BNFC | SPC

Polyhexamethylene biguinide (PHMB) 0.2% eye dropsu

Aciclovir
BNF | BNFC | SPC

Eye Ointment - 3%

1st line

Ganciclovir
BNF | BNFC | SPC

1.5mg per gram eye gel

2nd line use

There are currently no licensed topical antifungal agents available for the treatment of eye infections. Products can be obtained as unlicensed medicines to meet specific needs on request from an ophthalmologist or microbiologist.

MHRA Drug Safety Update (Aug 2017): Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration

Drug Name

Place in therapy

Brand name (where appropriate)

Classification

Details

Betamethasone sodium phosphate

First line

 

Green

1mg per mL Eye Drops
1mg per gram Eye Ointment

Dexamethasone (single agent)

Second line

Maxidex

Green (Alternative)

1mg per mL Eye Drops

Maxidex is Only licensed in children over 2 years of age

Dexamethasone (combination product)

Second line

Maxitrol

Green (Alternative)

Eye drops containing 1mg per mL dexamethasone in combination with hypromellose, neomycin and polymixin B
Ointment containing 1mg per mL dexamethasone in combination with neomycin and polymixin B

Prednisolone

Second line

 

Green (Alternative)

5mg per mL Eye Drops

10mg per mL Eye Drops

Loteprednol

Specialist initiation only

 

Green +

5mg per mL Eye drops

Fluorometholone

Specialist initiation only

FML

Green+

1mg per mL Eye Drops
For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist

Prednisolone

Specialist initiation only

 

Green+

1mg per mL Eye drops

3mg per mL Eye Drops
Treatment to be initiated on the advice of an ophthalmologist.

Prednisolone preservative-free

Specialist initiation only

 

Green+

1mg per mL preservative free eye drops (UNLICENSED)

3mg per mL preservative free eye drops (UNLICENSED)

5mg per mL preservative free eye drops (Minims)

10mg per mL preservative free eye drops
Treatment to be initiated on the advice of an ophthalmologist

Rimexolone

 

Specialist initiation only

 

Green+

1mg per mL eye drops  (UNLICENSED)

An option where Fluorometholone (FML) drops (which are much cheaper) are likely to be insufficiently effective.
To be initiated with the advice of an ophthalmologist.

Dexamethasone implant

 

 

Red

700 microgram intravitreal implant. To be used in line with the following NICE Technology Appraisals

NICE TA229 (July 2011)

NICE TA349 (July 2015)

Fluocinolone acetonide implant

 

 

Red

190 microgram intravitreal implant. To be used in line with the following NICE Technology Appraisals
NICE TA301 (November 2013 (replaced TA271 published Jan 2013 then withdrawn)

Betamethasone sodium phosphate
BNF | BNFC | SPC

Eye Drops - 0.1%

Ointment - 0.1%

Approved for first line use.

Dexamethasone
BNF | BNFC | SPC

Eye Drops - 0.1% (Maxidex)

Maxidex is Only licensed in children over 2 years of age

Approved for 2nd line use

Maxitrol
BNF | BNFC | SPC

 

Eye drops containing 1mg per mL dexamethasone in combination with hypromellose, neomycin and polymixin B
Ointment containing 1mg per mL dexamethasone in combination with neomycin and polymixin B

Approved for second line use.

Prednisolone
BNF | BNFC | SPC

Eye Drops - 0.5%, 1%

Approved for 2nd line use

Loteprednol
BNF | BNFC | SPC

5mg per mL Eye drops

Fluorometholone
BNF | BNFC | SPC

Eye Drops - 0.1%

For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist

Prednisolone eye drops 0.1%, 0.3%
BNF | BNFC | SPC

Eye drops 0.1%, 0.3%u

Treatment to be initated with the advice of an ophthalmologist.

Prednisolone preservative-free
BNF | BNFC | SPC

1mg per mL preservative free eye drops (UNLICENSED)
3mg per mL preservative free eye drops (UNLICENSED)
5mg per mL preservative free eye drops (Minims)
10mg per mL preservative free eye drops

Treatment to be initated with the advice of an ophthalmologist

Rimexolone
BNF | BNFC | SPC

1% eye drops – for use where Fluorometholone (FML) drops (which are much cheaper) are likely to be insufficiently effective.

To be initiated with the advice of an ophthalmologist.

Fluocinolone acetonide implant
BNF | BNFC | SPC

190 microgram intravitreal implant

Approved for use in accordance with the following NICE TAs

  • NICE TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy

Note: TA301 replaced TA271

Dexamethasone Implant
BNF | BNFC | SPC

700 microgram intravitreal implant (Ozurdex)

NICE TA229

NICE TA349

NICE TA460

Note: The Northern (NHS) Treatment Advisory Group recommends the sequential pharmacological management of MO secondary to RVO as per the North East Retina Group (NERG) RVO treatment pathway.

Olopatadine
BNF | BNFC | SPC

Eye Drops - 1mg/ml

Ortivine-Antistin
BNF | BNFC | SPC

Eye drops containing antazoline sulphate 0.5% + xylometazoline hydrochloride 0.05%

Adalimumab
BNF | BNFC | SPC

40mg injection (prefilled syringe)

Adalimumab is recommended as per NICE TA460 as an option for treating non-infectious uveitis in the posterior segment of the eye in adults with inadequate response to corticosteroids, only if there is:

  • active disease (that is, current inflammation in the eye) and
  • inadequate response or intolerance to immunosuppressants and
  • systemic disease or both eyes are affected (or 1 eye is affected if the second eye has poor visual acuity) and
  • worsening vision with a high risk of blindness (for example, risk of blindness that is similar to that seen in people with macular oedema).
Cyclopentolate Hydrochloride
BNF | BNFC | SPC

Eye Drops - 0.5%, 1%

05%, 0.1% Minims (preservative free)

Atropine Sulphate
BNF | BNFC | SPC

10mg per mL (0.5mL Unit dose) Eye Drops (Preservative – free)

10mL bottles of atropine should not be routinely prescribed

Tropicamide
BNF | BNFC | SPC

10mg per mL Eye Drops
5mg per mL (0.5mL Minims) Eye Drops (Preservative – free)
10mg per mL (0.5ml Minims Eye Drops (Preservative – free)

Phenylephrine
BNF | BNFC | SPC

25mg per mL (0.5mL Minims) Eye Drops
100mg per mL (0.5mL Minims) Eye Drops

The CSM has advised that all beta-blockers including those with cardioselectivity should not be used in patients with asthma or obstructive airways disease unless no other treatment is available. In such cases, the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.

SINGLE AGENTS

Place in therapy

Drug Name

Brand

Classification

Details

First line SINGLE agent  is a prostaglandin analogue (PGA)

 

If a PGA has been used with some reduction in Intra-ocular pressure but not to the level expected, try an alternative PGA before substituting with an agent from another therapeutic group

Latanoprost

(First line PGA)

 

Green

50micrograms per mL  Eye Drops

 

Should be prescribed generically Note the
MHRA Drug Safety Update (July 2015 which relates to the Xalatan brand only) : Latanoprost (Xalatan): increased reporting of eye irritation since reformulation.

MHRA Drug Safety Update (July 2015)

Latanoprost preservative-free

(First line Alternative if proven sensitivity to benzalkonium chloride

Monoprost

Green (Alternative)

50micrograms per mL (0.2mL Unit dose)  Eye Drops

 

 

Bimatoprost  (Alternative/ Second line PGA)

Lumigan

Green (Alternative)

100micrograms per mL Eye Drops

 

Bimatoprost preservative-free (Alternative/ Second line PGA)

Only to be used if proven sensitivity to benzalkonium chloride

Lumigan

Green (Alternative)

300micrograms per mL (0.4mL Unit dose)  Eye Drops

 

Tafluprost (Alternative/ Second line PGA)

Saflutan

Green (alternative)

15micrograms per mL  Eye Drops

Reserved for patients who cannot tolerate other prostaglandin analogues

There is currently no preservative- free formulation available.

Second line SINGLE agent is  a beta blocker (BB)

The CSM has advised that all beta-blockers including those with cardioselectivity should not be used in patients with asthma or obstructive airways disease unless no other treatment is available. In such cases, the risk of inducing bronchospasm should be appreciated and appropriate precautions taken

MHRA Drug Safety Update (July 2015)

 

Timolol (first line BB)

 

Green

2.5mg per mL Eye Drops

5mg per mL Eye Drops

Note that the following should not be prescribed to new patients. They are listed  on the formulary as PURPLE

  • long-acting Timolol 2.5mg per mL and 5mg per mL  (Timoptol LA)
  • Betaxolol 2.5mg per mL and 5mg per mL Eye drops (generic or Betoptic)
  • Carteolol 10mg per mL and 20mg per mL eye drops (Teoptic)

Not included in the formulary and should therefore not be prescribed to new patients

Third line SINGLE agent is a

Carbonic anhydrase inhibitors (CAI)

 

 

Dorzolamide (First line CAI)

Generic  available

Green

20mg per mL Eye Drops
20mg per mL (0.2mL Unit Dose) Eye Drops (preservative free)

Brinzolamide (Alternative First line CAI)

Generic  available

Green

10mg per mL Eye Drops

Acetazolamide (Second line CAI)

Tablets (generic)

MR capsules – (Daimox or Eytazox)

Green (Alternative)

250mg immediate- release Tablets

250mg Modified – release capsules

Acetazolamide (hospital only)

 

Red

500mg intravenous injection

Fourth Line SINGLE agents

Brimonidine tartrate

Generic available

Green

2mg per mL Eye Drops

Pilocarpine hydrochloride

Generic  available

Green

10mg per mL Eye Drops

20mg per mL Eye Drops

40mg per mL Eye Drops

Pilocarpine nitrite

Preservative-free

Generic  available

Green

20mg per mL (0.5mL Minims) Eye drops

 

Wherever possible uses a combined agent rather than separate to aid compliance

If the single agent has reduced pressure but not quite enough then ADD a second agent as a combination product (after individual agents have be tried)

 

First line COMBINATION is PGA with BB

 

 

Latanoprost with  Timolol

Xalacom

Green (Alternative)

Eye Drops containing 50micrograms latanoprost and 5mg timolol per mL

Bimatoprost with Timolol

Ganfort

Green (Alternative)

Eye Drops containing 300micrograms bimatoprost and 5mg  timolol per mL

Tafluprost  with Timolol

Taptiqom

Green (Alternative)

Eye Drops containing 15micrograms tafluprost and 5mg timolol per mL

Second  line COMBINATION is CAI with BB

Usually if patient cannot have a PGA or a PGA is contraindicated.

Brinzolamide with Timolol

Azarga

Green (Alternative)

Eye Drops containing 10mg of brinzolamide and 5mg of timolol per mL

Brinzolamide with

brimonidine

Simbrinza

Green (Alternative)

Eye Drops containing 10mg of brinzolamide and 2mg of brimonidine per mL

Dorzolamide with Timolol

Generic or Cosopt

Green (Alternative)

Eye Drops containing 20mg of dorzolamide and 5mg of timolol per mL

Dorzolamide with Timolol

Preservative – free (reserved for those who require a preservative free preparation)

Cosopt

Green (Alternative)

Single (0.2mL unit dose) Eye Drops containing 20mg of dorzolamide and 5mg of timolol per mL

Latanoprost
BNF | BNFC | SPC

Eye Drops - 50 microgram/ml

First line PGA.

Should be prescribed generically.

MHRA Drug Safety Update (July 2015) : Latanoprost (Xalatan): increased reporting of eye irritation since reformulation.

Latanoprost preservative-free
BNF | BNFC | SPC

50micrograms per mL (0.2mL Unit dose) Eye Drops

First line Alternative if proven sensitivity to benzalkonium chloride

Bimatoprost
BNF | BNFC | SPC

Eye Drops - 300microgram/ml

Alternative/ Second line PGA.

Bimatoprost preservative-free
BNF | BNFC | SPC

300micrograms per mL (0.4mL Unit dose) Eye Drops

Alternative/ Second line PGA.
Only to be used if proven sensitivity to benzalkonium chloride

Tafluprost
BNF | BNFC | SPC

15micrograms per mL Eye Drops


Reserved for patients who cannot tolerate other prostaglandin analogues
There is currently no preservative- free formulation available.

Timolol
BNF | BNFC | SPC

Eye Drops - 0.25% & 0.5%

First line beta-blocker

Betaxolol, carteolol and long-acting timolol eye drops are not included in the formulary and should not be used for new patients.

The CSM has advised that all beta-blockers including those with cardioselectivity should not be used in patients with asthma or obstructive airways disease unless no other treatment is available. In such cases, the risk of inducing bronchospasm should be appreciated and appropriate precautions taken (MHRA Drug Safety Update (July 2015)).

Dorzolamide
BNF | BNFC | SPC

Eye Drops - 2%

Single Use (preservative free) Drops - 2%

First line Carbonic anhydrase inhibitor.

Brinzolamide
BNF | BNFC | SPC

Eye Drops - 10mg/ml

Alternative First line Carbonic anhydrase inhibitor.

Acetazolamide
BNF | BNFC | SPC

250mg immediate- release Tablets
250mg Modified – release capsules

Second line carbonic anhydrase inhibitor.

Acetazolamide Injection
BNF | BNFC | SPC

500mg intravenous injection

Brimonidine
BNF | BNFC | SPC

Eye Drops - 0.2%

Fourth line single agent for glaucoma

Pilocarpine
BNF | BNFC | SPC

Eye Drops - 1%, 2%, 4%

Minims (preservative free) - 2%

Fourth line single agent for glaucoma

Latanoprost 50microgram/ml with Timolol 5mg/ml
BNF | BNFC | SPC

Latanoprost 50microgram/ml with Timolol 5mg/ml Eye Drops

First line combination for glaucoma.

If the single agent has reduced pressure but not quite enough then ADD a second agent as a combination product (after individual agents have be tried). Wherever possible uses a combined agent rather than separate to aid compliance

Ganfort (Bimatoprost 300microgram/ml, Timolol 5mg/ml)
BNF | BNFC | SPC

Eye Drops containing 300micrograms bimatoprost and 5mg timolol per mL

First line combination for glaucoma.

If the single agent has reduced pressure but not quite enough then ADD a second agent as a combination product (after individual agents have be tried). Wherever possible uses a combined agent rather than separate to aid compliance.

Tafluprost with Timolol
BNF | BNFC | SPC

Eye Drops containing 15micrograms tafluprost and 5mg timolol per mL

First line combination for glaucoma.

If the single agent has reduced pressure but not quite enough then ADD a second agent as a combination product (after individual agents have be tried). Wherever possible uses a combined agent rather than separate to aid compliance.

Brinzolamide with Timolol
BNF | BNFC | SPC

Eye Drops containing 10mg of brinzolamide and 5mg of timolol per mL

Second line COMBINATION is CAI with BB. Usually if patient cannot have a PGA or a PGA is contraindicated.

Brinzolamide with Brimonidine
BNF | BNFC | SPC

Eye Drops containing 10mg of brinzolamide and 2mg of brimonidine per mL

Second line COMBINATION is CAI with BB. Usually if patient cannot have a PGA or a PGA is contraindicated.

Dorzolamide 2% with Timolol 0.5%
BNF | BNFC | SPC

Eye Drops containing 20mg of dorzolamide and 5mg of timolol per mL
Single (0.2mL unit dose) Eye Drops containing 20mg of dorzolamide and 5mg of timolol per mL

 

Preservative – free reserved for those who require a preservative free preparation.

Second line COMBINATION is CAI with BB. Usually if patient cannot have a PGA or a PGA is contraindicated.

Tetracaine (Amethocaine)
BNF | BNFC | SPC

5mg per mL (0.5mL Minims) Eye drops (preservative free)
10mg per mL (0.5mL Minims) Eye drops (preservative free)

Oxybuprocaine (Benoxinate)
BNF | BNFC | SPC

0.4% minims eye drops

Proxymetacaine
BNF | BNFC | SPC

0.5% minims eye drops

Fluorescein with Lidocaine
BNF | BNFC | SPC

Single use Eye Drops containing 2.5mg fluoroscein and 40mg lidocaine per mL (0.5mL Minims) Eye drops (preservative free)

Drug Name

Place in therapy

Brand

Classification

Details

Hypromellose

First line

Generic available

Green

3mg per mL Eye Drops

5mg per mL Eye Drops

Hypromellose

Preservative free

First line

Generic available

Green

3mg per mL Minims Eye Drops

Carbomer 980

(polyacrylic Acid)

First line

Gel tears

Viscotears

 

Green

2mg per mL liquid gel

Hydroxyethylcellulose

1st line Alternatives

Artifical Tears Minims

Green (Alternative)

4.4mg per mL Minims Eye  Drops

White soft paraffin and mineral oil

1st line Alternatives

Xailin night

 

 

Retinol palmitate with white soft paraffin, light liquid paraffin and wool fat

1st line Alternatives

VitApos

Green (Alternative)

 

Carbomer 980 Preservative free

1st line Alternatives

Viscotears

Green (Alternative)

2mg per mL liquid gel
Preservative Free

Liquid Paraffin, Wool Fat, Yellow Soft Paraffin

1st line Alternatives

Lacrilube

Green (Alternative)

Eye Ointment

Simple Eye Ointment

1st line Alternatives

 

Green (Alternative)

 

Sodium Hyaluronate

(preservative free)

Second line ophthalmology initiation/ advice only

Clinitas

Green +

4mg per mL (0.5mL minims)

4mg per mL Eye Drops

Acetylcysteine  with Hypromellose

Second line ophthalmology initiation/ advice only

Ilube

Green+

5mg per mL  and 3.5mg per mL Eye Drops

Carmellose sodium

Second line ophthalmology initiation/ advice only

Celluvisc

Green +

5mg per mL Single Dose Unit (Preservative Free)

 10mg per mL Single Dose Unit (Preservative Free)

 

Sodium Chloride

Second line ophthalmology initiation/ advice only

 

Green +

5mg per mL Eye Drops

5mg per mL Eye Ointment

Only indicated for corneal oedema

Sodium Chloride

Preservative free

Second line ophthalmology initiation/ advice only

 

Green +

5mg per mL preservative-free Eye Drops
Only indicated for corneal oedema

Hydroxypropyl Guar

multidose bottles

 (last for 6 months after opening in primary care)

Third line

Systane

Green (Alternative)

Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients)
Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.

Hydroxypropyl Guar

Preservative free

Third line

Systane

Green (Alternative)

Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients)
Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.

Ciclosporin

Fourth line

ophthalmology initiation/ advice only

Ikervis®

Green+

1mg per mL Eye Drops
For treating 'severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes as per NICE TA369

Balanced Salt Solution

 

 

Red

Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags


For intra-ocular or topical irrigation during surgical procedures.

Hypromellose
BNF | BNFC | SPC

Eye Drops 0.3%, 0.5% OTC

3mg per mL Minims Eye Drops

First line

Carbomer 980 0.2% (equivalent to Viscotears)
BNF | BNFC | SPC

Eye Drops (1st line)

Viscotears Drops - Preservative Free (1st line alternative)

 

Artifical Tears Minims
BNF | BNFC | SPC

Hydroxyethylcellulose Artifical Tears Minims

4.4mg per mL Minims Eye Drops

Xailin Night
BNF | BNFC | SPC

White soft paraffin and mineral oil

VitApos
BNF | BNFC | SPC

Retinol palmitate with white soft paraffin, light liquid paraffin and wool fat eye ointment

Lacrilube (Liquid Paraffin, Wool Fat, Yellow Soft Paraffin)
BNF | BNFC | SPC

Eye Ointment

Simple Eye Ointment
BNF | BNFC | SPC
Sodium Hyaluronate (preservative free)
BNF | BNFC | SPC

4mg per mL (0.5mL minims) Clinitas®
4mg per mL Eye Drops Clinitas®

Second line ophthalmology initiation/ advice only

Ilube (Acetylcysteine 5%, Hypromellose 0.35%)
BNF | BNFC | SPC

5mg per mL and 3.5mg per mL Eye Drops

Second line, opthalmologist advice only

Celluvisc (Carmellose)
BNF | BNFC | SPC

5mg per mL Single Dose Unit (Preservative Free) (Celluvisc®)
10mg per mL Single Dose Unit (Preservative Free) (Celluvisc®)

 Second line use ophthalmology initiation/ advice only

Sodium Chloride
BNF | BNFC | SPC

5mg per mL Eye Drops
5mg per mL Eye Ointment
5mg per mL preservative-free Eye Drops

 

Second line use ophthalmology initiation/ advice only. Only indicated for corneal oedema.

Hydroxypropyl Guar (Systane)
BNF | BNFC | SPC

10ml Multidose bottles
0.8ml Preservative free vials

Third line use


Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients)


Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. The multidose bottle may be used for up to six months after opening in primary care.
In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.

Ciclosporin 0.1% Eye drops
BNF | BNFC | SPC

0.1% (1mg/1ml) eye drops (Ikervis®)

Fourth line ophthalmology initiation/ advice only

For treating 'severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes as per NICE TA369

CD&D APC Ciclosporin 0.1% eye drops (IKERVIS®) INFORMATION FOR PRIMARY CARE leaflet available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

Balanced Salt Solution
BNF | BNFC | SPC

Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags -

For intra-ocular or topical irrigation during surgical procedures.

Fluorescein
BNF | BNFC | SPC

2% minims eye drops, 1mg ophthalmic strips, Fluorets

Acetylcholine
BNF | BNFC | SPC

20mg in 2ml injection

Apraclonidine
BNF | BNFC | SPC

0.5% & 1% eye drops

Diclofenac Sodium
BNF | BNFC | SPC

0.1% eye drops + minims

Specialist initiation only: use for post-operative inflammation limited to patients where corticosteroids are unsuitable.

Ketorolac Trometamol
BNF | BNFC | SPC

0.5% eye drops

Specialist initiation only: use for post-operative inflammation limited to patients where corticosteroids are unsuitable.

Sodium Hyaluronate
BNF | BNFC | SPC

10mg in 1ml bag (Z-Hyalin® , formerly Ophthalin Gelbag ® )

14mg in 1ml syringe (Healon GV® )

Sodium Hyaluronate with Chondroitin
BNF | BNFC | SPC

Duovisc(R)

3mg per ml Sodium Hyaluronate with 4mg per ml Chondrotin sulphate

Note: The Northern (NHS) Treatment Advisory Group recommends the sequential pharmacological management of MO secondary to RVO as per the North East Retina Group (NERG) RVO treatment pathway.

 

NTAG Nov 2014: The Northern Treatment Advisory Group endorses the previously agreed NETAG decision i.e. that Verteporfin (Visudyne®) PDT is not recommended for use for the treatment of chronic CSCR.

Ranibizumab
BNF | BNFC | SPC

10mg in 1ml injection

NICE TA274, NICE TA155, NICE TA298 , NICE TA283

Note NICE TA237 was replaced by TA274

Bevacizumab
BNF | BNFC | SPC

1.25mg in 0.5ml syringe

See NTAG website for approved and not approved indications http://ntag.nhs.uk/html/eye.php

NTAG Bevacizumab for age related macular degeneration

Aflibercept
BNF | BNFC | SPC

4mg in 0.1ml injection

NICE TA294 - wet AMD

NICE TA305 – Macular oedema

NICE TA346 - diabetic macular oedema

NICE TA409

NICE TA486

Vertoporfin
BNF | BNFC | SPC

15mg powder for infusion.


NTAG Nov 2014: The Northern Treatment Advisory Group endorses the previously agreed NETAG decision i.e. that Verteporfin (Visudyne®) PDT is not recommended for use for the treatment of chronic CSCR.

Ocriplasmin▼
BNF | BNFC | SPC

2.5mg/ml concentrate for solution for intravitreal injection

NICE TA297

Ascorbic Acid
BNF | BNFC | SPC

10mg per mL preservative free Eye Drops

Tretinoin
BNF | BNFC | SPC

500micrograms per mL Eye Drops

Disodium edetate
BNF | BNFC | SPC

37mg per mL solution

Sodium Citrate
BNF | BNFC | SPC

10mg per mL Eye Drops

Ethanol
BNF | BNFC | SPC

20mg per mL Eye Drops

Multivitamin and mineral preparations for macular degeneration (ARMD)
BNF | BNFC | SPC

Multivitamin and mineral preparations for the management of age related macular degeneration (ARMD)

e.g. Macushield, Icaps, Occuvite preservision, Preservision lutein, Viteyes original plus-lutein, Ocuvite lutein, Visionace, Vitalux-plus

There is little evidence to support the use of lutein and antioxidant vitamin preparations to prevent progression of AMD, they are considered low priority and poor value for money. There is some concern that the high doses of vitamins and minerals needed may cause harm in some people.

A healthy diet rich in oily fish, leafy green vegetables and fresh fruit may be recommended or alternatively advise patients to purchase dietary supplements over the counter. Products are food supplements and not licensed medicines.

NTAG: Dietary Supplements for Treatment of Age-Related Macular Degeneration

NHSE: Items which should not routinely be prescribed in primary care - Guidance for
CCGs