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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
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...
11.04  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)
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Formulary
traffic lightGreen
  • 0.1% eye drops

 

 
 
Betamethasone with Neomycin
(Drops)
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Formulary
traffic lightAmber
  • Betamethasone sodium phosphate 0.1% with Neomycin sulfate 0.5% eye drops 

 

 
 
Dexamethasone
(Drops)
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Formulary
traffic lightAmber
  • 0.1% eye drops

 

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

 

 
 
Dexamethasone
(Ozurdex®)
(Intravitreal implant)
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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)
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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)
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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)
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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)
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Formulary
traffic lightAmber
  • 0.1% ophthalmic solution
 
 
Hydrocortisone sodium phosphate.
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Formulary
traffic lightRed
  • 3.35mg/ml eye drops 0.4ml unit dose
 
 
Loteprednol
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Formulary
traffic lightRed
  • Salisbury only
  • Non formulary at RUH and GWH
 
 
Prednisolone
(Drops)
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Formulary
traffic lightGreen
  • 0.5% ophthalmic drops, 1% ophthalmic drops
  • Preservative free available if indicated

 

 
 
Prednisolone
(Drops)
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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)
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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)
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Formulary
traffic lightGreen
  • 1mg/1ml ophthalmic drops.
 
 
Ketotifen (Ketofall®)
(Drops)
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Formulary
  • Amber - Salisbury & Swindon - 2nd-line after Olopatidine.
  • Non formulary - Bath.
  • 0.25mg/ml single dose unit drops SPC here.
 
 
 ....
 Non Formulary Items
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.
 
Antazoline 0.5% with Xylometazoline 0.05%
(Drops)

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Non Formulary

Self care only, available OTC

 
Azelastine (Optilast®)

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Non Formulary
 
Cenegermin

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Non Formulary
Link  NICE TA532: Cenegermin for treating neurotrophic keratitis
 
Emedastine (Emadine®)

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Non Formulary
 
Epinastine (Relestat®)

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Non Formulary
 
Lodoxamide (Alomide®)

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Non Formulary
 
Nedocromil
(Drops)

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Non Formulary

Discontinued by manufacturer 2018

 
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
 
  
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.  

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