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Royal United Hospitals Bath 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.

Ophthalmology-related Shared Care Agreements

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...
11.08  Expand sub section  Miscellaneous ophthalmic preparations
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
Self
  • 0.3% drops 10ml
 
Hypromellose 
(Ophthalmic drops Preservative Free)
View adult BNF View SPC online
First Choice
Green
  • 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
Green
  • 0.2% gel 10g
 
Carbomer 980 eye drops

(Ophthalmic liquid gel)
View adult BNF View SPC online
First Choice
Green
  • 0.2% gel 10g
  • Suitable for contact lense wearers
 
Carmellose 
(Ophthalmic drops)
View adult BNF View SPC online
First Choice
Green
  • 1% drop 10ml
  • Cellusan 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
  • 0.2% drops 10ml (Hydramed®)
  • 0.4% drops 10ml (Viz-Hyal®)
  • Preservative-free
  • To be prescribed in line with BSW Dry Eye Guidance
  • NOTE 0.4% strength is AMBER TLS in Swindon and only for use in Sjogren's
 
   
Acetylcysteine 
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
Amber
  • 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
Self
  • Carmellose 0.5ml, glycerol 1%, castor oil 0.25% 10ml
 
   
Ciclosporin (Ikervis®)
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
Amber
  • 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
Amber
  • 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
Green
  • 10ml
 
   
Propylene glycol 0.3% and polyethlene glycol 0.4% with hydroxypropyl guar

(Ophthalmic drops)
View adult BNF View SPC online
Formulary
Green
  • 10ml
 
   
Retinol palmitate with soft paraffins

View adult BNF View SPC online
Formulary
Self
  • 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
Red
  • Eye irrigation solutions 19ml, 500ml
 
   
Sodium Chloride 0.9%

(Ophthalmic drops)
View adult BNF View SPC online
Formulary
Green
  • 0.9% drops
 
   
Sodium Chloride 0.9%

(Single use ophthalmic drops)
Formulary
Green
  • 0.9% 0.5ml Preservative-free
 
   
Sodium Chloride 5% 
View adult BNF View SPC online
Formulary
Amber

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
Amber
  • 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
Red
  • 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
Red
  • 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
Red
  • 20mg powder and solvent for solution for intraocular irrigation
 
   
Apraclonidine 
(Single use opthalmic drops)
View adult BNF View SPC online
Formulary
Red
  • 0.1% solution
 
   
Cefuroxime intracameral injection
(Aprokam®)
(injection)
View adult BNF View SPC online
Formulary
Red
  •  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
Red
  • 1% and 2% minims
  • Ophthalmic strips
  • GWH only
  • Non formulary at RUH and Salisbury
 
   
Ketorolac 
(Drops)
View adult BNF View SPC online
Formulary
Red
  • 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
Amber
  • 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
Red
 
   
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
Red

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


View adult BNF View SPC online
Non Formulary
 
Carbomers 

View adult BNF View SPC online
Non Formulary
 
Carmellose Sodium (Carmize®)

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
 
Hydroxyethylcellulose
(Minims® Artificial Tears)

View adult BNF View SPC online
Non Formulary
 
Hydroxypropyl Guar (Systane®)

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

View adult BNF View SPC online
Non Formulary
 
Liquid Paraffin and Liquid Paraffin light eye drops


View adult BNF View SPC online
Non Formulary
 
Liquid Paraffin eye ointment


View adult BNF View SPC online
Non Formulary
 
Optive ® Fusion


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
 
Polyvinyl Alchohol (SnoTears®)

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

View adult BNF View SPC online
Non Formulary
 
Sodium Hyaluronate 
(Ophthalmic drops)

View adult BNF View SPC online
Non Formulary

Jan 2020 - Hylo-tears and Hylo-forte brands no longer included on the formulary. See BSW dry eye guidance for preferred brands of sodium hyaluronate.

 
Soybean oil unit dose eye drops
(Emustil®)

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

Red

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

Amber

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

Amber 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.  

Green

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

Self

Suitable for patient to be directed to buy themselves  

Grey

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

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red 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