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Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Ophthalmology-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

There are no shared care agreements (SCAs) relating to this chapter.

Self-care: Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance. For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
11.01  Expand sub section  Administration of drugs to the eye
 note 

If using multiple preparations, leave 5 minutes before each administration to ensure complete absorption of each preparation. Drops should be used before ointments.

Eye drop administration aids for patients with manual dexterity problems (including the elderly, visually impaired, arthritic) can be purchased from most community pharmacies or prescribed on FP10 prescriptions. Refer to the Drug Tariff for further details.

Preservative free products should be prescribed for patients with true preservative allergy, as diagnosed by a specialist.

11.02  Expand sub section  Control of microbial contamination
 note 

Nov 2019 - Guidance on the In Use Shelf Life for Eyedrops and Eye Ointments  

Also refer to BNF and local guidelines for information on the control of microbial contamination.

In outpatient departments and eye surgery single-use application packs should be used.

11.03  Expand sub section  Anti-infective eye preparations
 note 

Please refer to Management of Infections in Primary Care (QRG adults)

For information regarding 'specials' please see RCH/UKOPG - ophthalmic special products guidance 

11.03.01  Expand sub section  Antibacterials
Chloramphenicol
(Drops)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • 0.5% eye drops
  • 0.5% minims available for patients allergic to preservatives, administering more than 6 times a day, undergoing eye surgery
  • Eye drops available OTC for adults and children over 2 years
 
Chloramphenicol
(Ointment)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • 1% eye ointment
  • Eye ointment available OTC for adults and children over 2 years
 
Amikacin
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 500mg/2ml solution for injection 
  • GWH only. For treatment of Acanthamoeba keratitis.
  • Non formulary at RUH and SFT
 
 
Cefuroxime
(Drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 5% eye drops
  • 5% preservative-free eyedrops (GWH only)
 
 
Chlortetracycline
(Ointment)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1% eye ointment 
  • RUH only. Non formulary at GWH and SFT
 
 
Ciprofloxacin
(Drops)
View adult BNF View SPC online
Formulary
  • 0.3% eye drops

  • Green Salisbury
  • Red RUH and GWH - For corneal crystallisation and endophthalmitis
 
 
Erythromycin
(Ointment)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.5% eye ointment
  • GWH only for suspected chlamydia in neonates on the advice of paediatrician
  • Non formulary at RUH and SFT
 
 
Fusidic Acid
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1% eye drops

Fusidic acid eye drops are no longer included in primary care guidance for the management of bacterial conjunctivitis due to high cost (£29.06 per 5g May 2019) and poor activity for a self-limiting condition. 

Use should be restricted to people who:
- Are pregnant
- Have a personal or family history of blood dyscrasias, such as aplastic anaemia
- Are intolerant of chloramphenicol
- Need a twice-a-day treatment for infective conjunctivitis
See CKS topic for more information

 

 
 
Gentamicin
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.3% eye drops
 
 
Gentamicin
(Drops)
View adult BNF View SPC online
Formulary
  • Red - GWH.
  • Non-formulary - SFT & RUH.
  • 1.5 % preservative-free eye drops.
 
 
Levofloxacin
(Drops)
View adult BNF View SPC online
Formulary
  • 5mg/ml eye drops

  • Green Salisbury
  • Amber BaNES and Swindon
 
 
Moxifloxacin
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 400mg tablets 
  • GWH only - For the treatment of endophthalmitis, 400mg OD for 10 days.
  • Non formulary at RUH and SFT
 
 
Ofloxacin
(Drops)
View adult BNF View SPC online
Formulary
  • 0.3% eye drops

  • Amber in BaNES and Swindon
  • Green in Salisbury

 

 
 
Penicillin
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 5000 units in 1ml eye drops
  • GWH only. Non formulary at RUH and SFT
 
 
Polihexanide
(Drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.02% eye drops
  • GWH and RUH only. Non formulary at SFT
 
 
Propamidine Isetionate
(Drops and ointment)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.1% eye drops
  • 0.15% ointment
  • GWH only. Non formulary at RUH and SFT
 
 
Vancomycin
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH only. For intravitreal injection
  • Non formulary at RUH and SFT
 
 
11.03.02  Expand sub section  Antifungals to top
 note 

Antifungal eye preparations are not generally available and are unlicensed. Only use under specialist advice.

Amphotericin
(Intravitreal injection)
Formulary
traffic lightRed
  • GWH only - Only for treatment of fungal endophthalmitis after consultant or senior ophthalmologist approval. See information sheet for dilution instructions.
  • Non formulary at RUH and SFT
 
 
11.03.03  Expand sub section  Antivirals
Ganciclovir
(Gel)
View adult BNF View SPC online
Formulary
  • 0.15% eye gel

  • Green in Salisbury
  • Amber in Swindon and BaNES - ONLY for patients with corneal stromal herpes simplex keratitis, aciclovir-resistant herpes simplex keratitis & herpetic keratouveitis on the advice of a Consultant ophthalmologist

 

 
 
11.04  Expand sub section  Corticosteroids and other anti-inflammatory preparations
 note 

See MHRA Drug Safety Update: rare risk of central serous chorioretinopathy with local and systemic administration of corticosteriods August 2017

For information regarding 'specials' please see Royal College of Opthalmologists Special Products August 2016

11.04.01  Expand sub section  Corticosteroids
Betamethasone
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.1% eye drops

 

 
 
Betamethasone with Neomycin
(Drops)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Betamethasone sodium phosphate 0.1% with Neomycin sulfate 0.5% eye drops 

 

 
 
Dexamethasone
(Drops)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 0.1% eye drops

 

 
 
Dexamethasone (Minims®)
(Drops)
View adult BNF View SPC online
Formulary
    • Amber - Bath & Swindon
    • Non formulary - Salisbury
    • 0.1% preservative free eye drops in 0.5ml unit doses

 

 
 
Dexamethasone
(Ozurdex®)
(Intravitreal implant)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 700 micrograms intravitreal implant in applicator
  • For the treatment of adults with macular oedema following either branch retinal vein occlusion or central retinal vein occlusion ONLY in line with local commissioning criteria and NICE TA229.
  • For the treatment of patients with sight problems caused  diabetic macular oedema, in line with NICE TA349.
  • For the treatment of patients with non-infectious uveitis, in line with NICE TA460Only available in specialist centres (not RUH or SFT).

 

 
Link  NICE TA229: Macular oedema secondary to retinal vein occlusion
Link  NICE TA349: Diabetic Macular Oedema
Link  NICE TA460: Non-infectious uveitis
 
Dexamethasone with Neomycin and Polymyxin B sulphate
(Drops and ointment)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Dexamethasone 1 mg/gram with neomycin 3500 units/gram and polymyxin B sulfate 6000 unit per 1 gram in 3.5g eye ointment
  • Dexamethasone 1 mg/ml with hypromellose 5 mg/ml with neomycin (as neomycin sulfate) 3500 units/ml with polymyxin B sulfate 6000 units/ml in 5ml eye drops
 
 
Dexamethasone with Tobramycin
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Dexamethasone 1 mg/ml with tobramycin 3 mg/ml eye drops.
  • Salisbury only
  • Non formulary in BaNES and Swindon
 
 
Fluocinolone (Iluvien®)
(Intravitreal implant)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • For the treatment of chronic diabetic macular oedema after an inadequate response to prior therapy. In line with NICE TA301 Nov 2013.  Patients need to have gained 10 or more ETDRS letters of visual acuity between baseline and month 36 to receive a further implant at month 36 according to NICE TA301.
  • Note: concurrent treatment to both eyes not recommended (SPC).
  • A single implant releases fluocinolone for up to 36 months.
  • Implantation may not be repeated more frequently than every 36 months due to lack of evidence base of benefit.
 
Link  Iluvien Educational Risk Minimisation Materials
Link  NICE TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
Link  NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
 
Fluorometholone
(Solution)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 0.1% ophthalmic solution
 
 
Hydrocortisone sodium phosphate.
View adult BNF View SPC online
Formulary
traffic lightRed
  • 3.35mg/ml eye drops 0.4ml unit dose
 
 
Loteprednol
View adult BNF View SPC online
Formulary
traffic lightRed
  • Salisbury only
  • Non formulary at RUH and GWH
 
 
Prednisolone
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.5% ophthalmic drops, 1% ophthalmic drops
  • Preservative free available if indicated

 

 
 
Prednisolone
(Drops)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • 0.1% and 0.3% ophthalmic drops  NOTE STRENGTHS
  • GWH only - For use in herpes simplex keratitis only
  • These strengths are non formulary at RUH and Salisbury
 
 
11.04.02  Expand sub section  Other anti-inflammatory preparations
Sodium Cromoglicate
(Drops)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 2% ophthalmic drops
  • If issuing FP10, ensure that prescriptions are written for 13.5ml, not 10ml or ‘1op’ as these preparations are ‘over-the-counter’ products and are more expensive.
 
 
Olopatadine
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1mg/1ml ophthalmic drops.
 
 
Ketotifen (Ketofall®)
(Drops)
View adult BNF
Formulary
  • Amber - Salisbury & Swindon - 2nd-line after Olopatidine.
  • Non formulary - Bath.
  • 0.25mg/ml single dose unit drops SPC here.
 
 
11.05  Expand sub section  Mydriatics and cycloplegics to top
11.05  Expand sub section  Antimuscarinics
Atropine
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1% ophthalmic drops

 

 
Link  Anticholinergic medicines (information for patients)
 
Atropine Sulphate
(Single use drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1% single use minims

 

 
Link  Anticholinergic medicines (information leaflet for patients)
 
Cyclopentolate drops
(Drops and minims)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.5% and 1% ophthalmic drops
  • 0.5% and 1% minims

 

 
 
Tropicamide
(Ophthalmic drops )
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.5% and 1%
 
 
11.05  Expand sub section  Sympathomimetics
Phenylephrine 5.4mg and Tropicamide 0.28mg Ophthalmic Insert
View adult BNF View SPC online
Formulary
traffic lightRed
  • RUH and Salisbury only
  • Non formulary at GWH
 
 
Phenylephrine Hydrochloride
View adult BNF View SPC online
Formulary
traffic lightRed
  • Phenylephrine 2.5% and 10% eyedrops
  • GWH only - Phenylephrine 1% injection for consultant/senior ophthalmologist approval
 
 
11.06  Expand sub section  Treatment of glaucoma
11.06  Expand sub section  Beta-blockers
 note 

Systemic absorption may occur with eye drops containing beta-blockers so these are contra-indicated in patients with bradycardia, heart block and uncontrolled heart failure and should be used with extreme care in patients with asthma.

Timolol
(Ophthalmic drops)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 0.25% and 0.5% drops

 

 

 
Betaxolol
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.5% ophthalmic drops and 0.25% ophthalmic solution

 

 
 
Timolol
(Preservative Free drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • BaNES and Swindon
  • Non formulary in Salisbury
  • 2.5mg/ml and 5mg/ml preservative free ophthalmic drops
 
 
Timolol
(Ophthalmic gel)
View adult BNF View SPC online
Formulary
  •  Amber - Swindon
  • Non formulary- Bath & Salisbury
  • 0.1 % ophthalmic gel
 
 
11.06  Expand sub section  Prostaglandin analogues to top
Latanoprost
(Drops)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 50microgram/ml ophthalmic drops
  • Preservative free available if indicated as per BSW glaucoma guidance

 

 
Bimatoprost with Timolol
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 300micrograms and 5mg/ml combination ophthalmic drops

 

 
 
Latanoprost 0.005% with Timolol 0.5%
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Latanoprost 50micrograms, Timolol 5mg/ml
  • Note: Fixapost® preservative free included on formulary at SFT 
 
 
Travoprost
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 40microgram ophthalmic drops

 

 
 
Travoprost with Timolol
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 40microgram with 5mg/ml Timolol ophthalmic drops
 
 
Bimatoprost
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 100microgram/ml ophthalmic drops
  • 300microgram/ml preservative free single use eyedrops available where indicated as per BSW glaucoma guidance
 
 
11.06  Expand sub section  Sympathomimetics
Brimonidine Tartrate
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.2% ophthalmic eye drops
  • Note - higher risk of side-effects and sensitivity.

 

 
 
11.06  Expand sub section  Carbonic anhydrase inhibitors and systemic drugs
Brinzolamide 1% with Timolol 0.5%
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • Brinzolamide 1% with Timolol 0.5% 
 
 
Acetazolamide
(Tablets/capsules)
View adult BNF View SPC online
Formulary
  • Green BaNES and Salisbury for glaucoma
  • Amber Swindon for glaucoma
  • 250mg tablets and 250mg MR capsules (NB capsules more costly and stock shortages until at least July 2020)
  • Note: at RUH and GWH, acetazolamide is included on the formulary for idiopathic intracranial hypertension as Amber Unlicensed indication
  • Note - Private prescription only for prophylaxis of mountain sickness. Not licensed and NOT for prescribing on NHS. For further information see link below 
 
Link  SPS: Prevention of Acute Mountain Sickness
 
Acetazolamide Injection
View adult BNF View SPC online
Formulary
traffic lightRed
  • 500mg injection
 
 
Brinzolamide
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1% eye drops

 

 
 
Brinzolamide 10mg/ml & brimonidine 2mg/ml
View adult BNF View SPC online
Formulary
traffic lightGreen
  • ophthalmic drops containing 10 mg/mL of brinzolamide and 2 mg/mL of brimonidine tartrate equivalent to 1.3 mg of brimonidine.

BaNES/Wilts - For use as per Glaucoma guidance 
Swindon - Not on formulary

 
 
Dorzolomide
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 2% eye drops
 
 
Dorzolomide 2% with Timolol 0.5%
(Ophthalmic solution)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 5ml ophthalmic drops

 

 
 
11.06  Expand sub section  Miotics
Pilocarpine
(Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 2% and 4% eyedrops.
  • 2% preservative-free minims (Swindon only).

 

 
 
11.07  Expand sub section  Local anaesthetics
Lidocaine 4% with Fluorescein 0.25%
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.5ml unit dose.
 
 
Oxybuprocaine
(Drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.4% single use drops
 
 
Proxymetacaine
(Drops)
View adult BNF View SPC online
Formulary
  • Red at RUH
  • Green in Salisbury and Swindon
  • 0.5% single use drops
 
 
Tetracaine
(Drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.5% and 1% single use drops
 
 
11.08  Expand sub section  Miscellaneous ophthalmic preparations to top
Hyaluronidase
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1,500unit powder for solution for injection ampoules
  • adjunct to local anaesthesia in ophthalmology
 
 
11.08.01  Expand sub section  Tear deficiency, ocular lubricants, and astringents
 note 

Self-care of tear deficiency, ocular lubricants and astringents

Please see BSW Dry Eye Guidance

Many of the products in this section are available to purchase over-the- counter. Patients are encouraged to self-care with the support of their community pharmacist, in the first instance.

 

Hypromellose
(Ophthalmic drops 0.3%)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • 0.3% drops 10ml
 
Hypromellose
(Ophthalmic drops Preservative Free)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 0.3% drops 10ml
  • Evolve is the most cost-effective preservative-free hypromellose preparation in primary care
  • Swindon only - use Hydromoor brand in secondary care
 
Carbomer
(Ophthalmic liquid gel)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 0.2% gel 10g
 
Carbomer 980 eye drops
(Ophthalmic liquid gel)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 0.2% gel 10g
  • Suitable for contact lense wearers
 
Carmellose
(Ophthalmic drops)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 1% drop 10ml
  • VIZcellulose® is the most cost-effective preservative-free carmellose preparation in primary care
  • Swindon only - Use Celluvisc SDUs in secondary care.
 
Sodium Hyaluronate
(Ophthalmic drops)
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • 0.2% drops 10ml (Hydramed®)
  • 0.4% drops 10ml (Viz-Hyal®)
  • Preservative-free
  • To be prescribed in line with BSW Dry Eye Guidance
 
 
Acetylcysteine
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Acetylcysteine eye drops 5%, hypromellose 0.35% 10ml (includes benzalkonium chloride, disodium edetate)
  • Specialist initiation - Only if filamentary keratitis present.
 
 
Carboxymethylcellulose, glycerine & castor oil eye drops
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Carmellose 0.5ml, glycerol 1%, castor oil 0.25% 10ml
 
 
Ciclosporin (Ikervis®)
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 0.1% drops (1 mg/mL eye drops, emulsion)
  • Note - Ensure correct product is prescribed; available products have different licensing information and TLS. 
  • Ikervis ® is licensed for the treatment of severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes.
  • Verkazia®  is licensed for the treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents. See here
 
Link  NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
 
Liquid Paraffin eye ointment
(Lacri-lube®)
(Opthalmic oinment)
View adult BNF
Formulary
traffic lightAmber
  • GWH for recurrent erosions only. Not on formulary at RUH/SFT
  • Consider Hylo-night (formerly VitA-POS or Hydramed night)
 
 
Propylene glycol
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 10ml
 
 
Propylene glycol 0.3% and polyethlene glycol 0.4% with hydroxypropyl guar
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 10ml
 
 
Retinol palmitate with soft paraffins
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 5g Preservative-free ointment

Better known by brand names:

- Hydramed Night® (Retinol palmitate 250iu/g, liquid paraffin, white soft paraffin, wool fat) 5g (PF) 3/12 expiry

- VitA-POS® (Retinol palmitate 250iu/g, liquid paraffin, wool fat) 5g (PF) 6/12 expiry NOTE from April 2020, VitA-POS is rebranding as HYLO NIGHT. The ointment ingredients and composition remaining the same as VitA-POS.

 
 
Sodium Chloride
(Balanced salt solution)
Formulary
traffic lightRed
  • Eye irrigation solutions 19ml, 500ml
 
 
Sodium Chloride 0.9%
(Single use ophthalmic drops)
Formulary
traffic lightGreen
  • 0.9% 0.5ml Preservative-free
 
 
Sodium Chloride 0.9%
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.9% drops
 
 
Sodium Chloride 5%
View adult BNF View SPC online
Formulary
traffic lightAmber

Sodium chloride 5% (preserved) eyedrops for patients with corneal oedema or corneal erosions on the advice of a Consultant Ophthalmologist. In primary care these should be prescribed as Hypersal 5% eyedrops or Sodium Chloride 5% eyedrops (Alissa®) as other unlicensed products are prohibitively expensive.

Sodium Chloride 5% PF eye ointment for patients with corneal oedema or corneal erosions, unable to tolerate preserved drops, on the advice of a Consultant Ophthalmologist. In primary care these should be prescribed as Sodium Chloride 5% PF eye ointment (Alissa®) as other unlicensed products are prohibitively expensive.

Please note - Sodium Chloride 5% eye products not on formulary at SFT

 
 
Sodium Hyaluronate 0.1%, Co-enzyme Q10 0.1%, Vitamin E
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 0.1% Preservative-free (VisuXL®)
  • 2 month expiry
  • Specialist initiation only in line with BSW dry eye guidance 
 
 
Ciclosporin
(Ophthalmic ointment)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • 0.2% eye ointment - Unlicensed preparation
  • GWH only - ONLY for patients who respond to ciclosporin but fail to tolerate Ikervis presentation. Only to be prescribed on yellow GWH hospital outpatient prescription and NOT FP10
  • Non formulary in RUH and SFT

 

 
 
Hypromellose 2% in balanced salt solution (HPMC)
Unlicensed Drug Unlicensed
traffic lightRed
  • For use within GWH only

 

 
 
11.08.02  Expand sub section  Ocular diagnostic and peri-operative preparations and photodynamic treatment
Acetylcholine
(Intra-ocular irrigation)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 20mg powder and solvent for solution for intraocular irrigation
 
 
Apraclonidine
(Single use opthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1% single use eye drops 

     

 
 
Cefuroxime intracameral injection
(Aprokam®)
(injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  •  3mg in 0.3ml pre-prepared injection.
  •  50mg vial.
 
 
Diclofenac
(Drops)
View adult BNF View SPC online
Formulary
  • Green Swindon - Pre-operative & immediately post - operatively. For short-term pain relief in episcleritis, cornial abrasion or foreign bodies. Avoid single use except in allergy to preservatives
  • Red RUH (Single use eye drops 0.1%)
  • Non formulary in Salisbury
 
Link  Eye topical NSAIDs 3Ts
 
Fluorescein
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1% and 2% minims
  • Ophthalmic strips
  • GWH only
  • Non formulary at RUH and Salisbury
 
 
Ketorolac
(Drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.5% ophthalmic drops
  • Note at GWH - For inflammation requiring extended treatment (up to 21 days) following ocular surgery
 
Link  Eye topical NSAIDs - 3TS
 
Nepafenac (Nevanac)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Salisbury only
  • Non formulary in BaNES and Swindon
 
 
Perflurodecaline (Heavy Liquid)
(Injection)
View adult BNF View SPC online
Formulary
  •  Red- GWH - For use in Ophthalmology.
  •  Non-formulary- SFT & RUH.
  •  5ml vial.
 
 
Sodium Hyaluronate
(Pre-filled syringe 1%)
View adult BNF View SPC online
Formulary
traffic lightRed
 
 
Tisseel
(RTU Kit)
View adult BNF View SPC online
Formulary
  •  Red - GWH - For use in Ophthalmology.
  •  Non-formulary - SFT & RUH
 
 
Mydrane Injection
(0.2 ml solution contains 0.04 mg of tropicamide, 0.62 mg of phenylephrine hydrochloride and 2 mg of lidocaine hydrochloride)
View SPC online
Restricted Drug Restricted
traffic lightRed

GWH Eye Theatre Use Only During Post COVID-19

  • Intracameral injection
  • Added to formulary for 6 months during post COVID-19 (review date Jan 21)
 
 
11.08.02  Expand sub section  Subfoveal choroidal neovascularisation
 note 

BSW STP ophthalmology Blueteq pathways for Aflibercept and Ranibizumab

Aflibercept (Eylea®)
(Intravitreal injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
 
Link  NICE TA294: Aflibercept solution for injection for treating wet age‑related macular degeneration
Link  NICE TA305: Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA346: Aflibercept for treating diabetic macular oedema
Link  NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
 
Bevacizumab (Avastin®)
(Intravitreal injection)
View adult BNF View SPC online
Formulary
traffic lightRed
CCG
BlueTeq
 
Link  Policy for Bevacizumab for the treatment of rubeotic/neovascular glaucoma and uncontrolled Proliferative Diabetic Retinopathy prior to laser or vitrectomy (adults)
Link  Policy for use of Avastin® (bevacizumab) under the NICE threshold in wet AMD
 
Ranibizumab (Lucentis®)
(Intravitreal injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
 
Link  NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA274: Ranibizumab for treating diabetic macular oedema
Link  NICE TA283:Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA298: Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
 
11.09  Expand sub section  Contact lenses
 note 

Contact lense solutions are not allowed on FP10 prescriptions.

Refer to BNF for recommendations reagrding contact lenses and drug treatment

11.99.99.99  Expand sub section  Miscellaneous to top
 note 

Nutritional supplements for age-related macular degeneration are NON-FORMULARY. See 9.6.7 for further information 

 

Disodium edetate
(Eyedrop)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • 0.37% eyedrop Unlicensed
  • RUH and GWH - for chelation of cornea for calcific band keratopathy.
  • Not on formulary at SFT
 
 
Cytotoxic Drug Fluorouracil
(Injection)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • Swindon only - used in theatre intra-operatively (trabeculectomy) and for needling of trabeculectomy post-op. Special chemotherapeutic agent manufactured for individual patients. 48 hours notice required. Consultant ophthalmologist prescription only.
  • For licensed indications for fluorouracil see chapter 8.1.3 and chapter 13.8.1(topical)
  • Non formulary at RUH and SFT

 

 
 
 ....
 Non Formulary Items
Acetylcysteine 10% eye drops

View adult BNF View SPC online
Non Formulary
 
Aciclovir
(Ointment)

View adult BNF View SPC online
Non Formulary
 
Adalimumab
(Imraldi®Amgevita® Humira®) Black Triangle
(Ophthalmology)

View adult BNF View SPC online
Restricted Drug Restricted
High Cost Medicine
NHS England
  • Non-Formulary EXCEPT when used for Uveitis in accordance with NICE TA 460 from Specialist Centres 
  • Check Trust contracting arrangements.
 
Amo Complete

View adult BNF View SPC online
Non Formulary
 
Antazoline 0.5% with Xylometazoline 0.05%
(Drops)

View adult BNF View SPC online
Non Formulary

Self care only, available OTC

 
Azelastine (Optilast®)

View adult BNF View SPC online
Non Formulary
 
Azithromycin (Azyter®)
(ophthalmic)

View adult BNF View SPC online
Non Formulary
 
Benzylpenicillin
(ophthalmic)

View adult BNF View SPC online
Non Formulary
 
Boston Advance Cleaner

View adult BNF View SPC online
Non Formulary
 
Boston Advance Conditioning Solution

View adult BNF View SPC online
Non Formulary
 
Carteolol
(Ophthalmic drops 1%)

View adult BNF View SPC online
Non Formulary
 
Ceftazidime
(ophthalmic)

View adult BNF View SPC online
Non Formulary
 
Cenegermin

View adult BNF View SPC online
Non Formulary
Link  NICE TA532: Cenegermin for treating neurotrophic keratitis
 
Controlled Drug  Cocaine

View adult BNF View SPC online
Non Formulary
 
Commercial eye hygiene preparations

View adult BNF View SPC online
Non Formulary

Commercial eye hygiene preparations are non-formulary and not recommended for prescribing due to limited evidence to support their effectiveness over usual eyelid hygiene methods.

Do not routinely prescribe commercial eyelid hygiene preparations (such as Blephasol®, Blephaclean®, Blephagel®, Suppranettes® wipes or lotions, or eye compresses like Hot Eye Compress®, Meibopatch®, MGDRx Eye Bag®). These are available for self-purchase OTC.

Further information for prescribers:

  • Advise and support patients to develop a lid hygiene routine using a home-made warm compress. See CKS
  • Supply patients with an information leaflet from Moorfield’s Eye Hospital
 
Dipivefrine Hydrochloride
(Propine®)

View adult BNF View SPC online
Non Formulary
 
Econazole 1% eye drops

View adult BNF View SPC online
Non Formulary
 
Emedastine (Emadine®)

View adult BNF View SPC online
Non Formulary
 
Epinastine (Relestat®)

View adult BNF View SPC online
Non Formulary
 
Foscarnet intravitreal injection

View adult BNF View SPC online
Non Formulary
 
Homatropine
(Opthalmic drops 1%)

View adult BNF View SPC online
Non Formulary
 
Hydroxyethylcellulose
(Minims® Artificial Tears)

View adult BNF View SPC online
Non Formulary
 
Idebenone (Raxone®)

View adult BNF View SPC online
Non Formulary
 
Levobunolol
(Drops)

View adult BNF View SPC online
Non Formulary
  • 0.5% ophthalmic drops
  • Note Jan 2020 - Non-formulary for new patients as discontinued by manufacturer. See glaucoma guidance for alternatives  

 

 
Lodoxamide (Alomide®)

View adult BNF View SPC online
Non Formulary
 
Metipranolol
(Minims® Metipranolol)

View adult BNF View SPC online
Non Formulary
 
Miconazole 1% eye drops

View adult BNF View SPC online
Non Formulary
 
Nedocromil
(Drops)

View adult BNF View SPC online
Non Formulary

Discontinued by manufacturer 2018

 
Neomycin Eye drops

View adult BNF View SPC online
Non Formulary
 
Optive ® Fusion

View adult BNF View SPC online
Non Formulary
 
Oxysept 1 Step

View adult BNF View SPC online
Non Formulary
 
Paraffin Yellow Soft
(Simple eye ointment)

View adult BNF View SPC online
Non Formulary
 
Pegaptanib Sodium
(Macugen®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Polymyxin B Sulphate eye ointment
(Polyfax®)

View adult BNF View SPC online
Non Formulary
 
Polyvinyl Alcohol
(Liquifilm Tears or Sno Tears®)

View adult BNF View SPC online
Non Formulary
 
Povidone iodine 5%
(ophthalmic)

View adult BNF View SPC online
Non Formulary
 
Prednisolone 0.5% with Neomycin 0.5%
(Predsol-N®)
(Ophthalmic drops)

View adult BNF View SPC online
Non Formulary

Discontinued

 
Sodium cromoglicate preservative free

View adult BNF View SPC online
Non Formulary
 
Soybean oil unit dose eye drops
(Emustil®)

View adult BNF View SPC online
Non Formulary
 
Tafluprost and Timolol
(Taptiqom®)

View adult BNF View SPC online
Non Formulary
 
Total Care Daily Cleaner

View adult BNF View SPC online
Non Formulary
 
Total Care Disinfecting and Wetting Solution

View adult BNF View SPC online
Non Formulary
 
Trifluorothymidine eye drops

View adult BNF View SPC online
Non Formulary
 
Verteporfin (Visudyne®)
(Injection)

View adult BNF View SPC online
Non Formulary
Red
High Cost Medicine
Link  NICE TA68: Photodynamic therapy for age related macular degeneration
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary