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 |
|
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) |
1.5mg per gram Eye OintmentOTC
1mg per mL Eye DropsOTC
Approved for First-line use
Eye drops - 0.5%OTC
Ointment - 1%OTC
Preservative-free = 0.5% preservative-free Minims
Approved for first-line use.
Eye drops - 0.3%
3mg per mL Minims Eye drops (Preservative-free)( UNLICENSED)
Approved for second line use.
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.
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 |
|
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 |
|
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 |
|
Prednisolone |
Specialist initiation only |
|
Green+ |
1mg per mL Eye drops 3mg per mL Eye Drops |
|
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 |
|
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. |
|
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 |
Eye Drops - 0.1%
Ointment - 0.1%
Approved for first line use.
Eye Drops - 0.1% (Maxidex)
Maxidex is Only licensed in children over 2 years of age
Approved for 2nd line use
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.
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
Eye drops 0.1%, 0.3%u
Treatment to be initated with the advice of an ophthalmologist.
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
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.
190 microgram intravitreal implant
Approved for use in accordance with the following NICE TAs
Note: TA301 replaced TA271
700 microgram intravitreal implant (Ozurdex)
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.
Eye drops containing antazoline sulphate 0.5% + xylometazoline hydrochloride 0.05%
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:
Eye Drops - 0.5%, 1%
05%, 0.1% Minims (preservative free)
10mg per mL (0.5mL Unit dose) Eye Drops (Preservative – free)
10mL bottles of atropine should not be routinely prescribed
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)
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 |
|||||
|
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
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 |
|||||
|
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 |
||||||
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.
50micrograms per mL (0.2mL Unit dose) Eye Drops
First line Alternative if proven sensitivity to benzalkonium chloride
300micrograms per mL (0.4mL Unit dose) Eye Drops
Alternative/ Second line PGA.
Only to be used if proven sensitivity to benzalkonium chloride
15micrograms per mL Eye Drops
Reserved for patients who cannot tolerate other prostaglandin analogues
There is currently no preservative- free formulation available.
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)).
Eye Drops - 2%
Single Use (preservative free) Drops - 2%
First line Carbonic anhydrase inhibitor.
Eye Drops - 10mg/ml
Alternative First line Carbonic anhydrase inhibitor.
250mg immediate- release Tablets
250mg Modified – release capsules
Second line carbonic anhydrase inhibitor.
Eye Drops - 1%, 2%, 4%
Minims (preservative free) - 2%
Fourth line single agent for glaucoma
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
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.
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.
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.
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.
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.
5mg per mL (0.5mL Minims) Eye drops (preservative free)
10mg 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 |
|
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 |
|
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) |
|
Hydroxypropyl Guar Preservative free |
Third line |
Systane |
Green (Alternative) |
Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients) |
|
Ciclosporin |
Fourth line ophthalmology initiation/ advice only |
Ikervis® |
Green+ |
1mg per mL Eye Drops |
|
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
|
Eye Drops (1st line)
Viscotears Drops - Preservative Free (1st line alternative)
Hydroxyethylcellulose Artifical Tears Minims
4.4mg per mL Minims Eye Drops
Retinol palmitate with white soft paraffin, light liquid paraffin and wool fat eye ointment
4mg per mL (0.5mL minims) Clinitas®
4mg per mL Eye Drops Clinitas®
Second line ophthalmology initiation/ advice only
5mg per mL and 3.5mg per mL Eye Drops
Second line, opthalmologist advice only
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
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.
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.
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/
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.
0.1% eye drops + minims
Specialist initiation only: use for post-operative inflammation limited to patients where corticosteroids are unsuitable.
0.5% eye drops
Specialist initiation only: use for post-operative inflammation limited to patients where corticosteroids are unsuitable.
10mg in 1ml bag (Z-Hyalin® , formerly Ophthalin Gelbag ® )
14mg in 1ml syringe (Healon GV® )
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.
10mg in 1ml injection
NICE TA274, NICE TA155, NICE TA298 , NICE TA283
Note NICE TA237 was replaced by TA274
1.25mg in 0.5ml syringe
See NTAG website for approved and not approved indications http://ntag.nhs.uk/html/eye.php
4mg in 0.1ml injection
NICE TA346 - diabetic macular oedema
2.5mg/ml concentrate for solution for intravitreal injection
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