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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.

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
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%)
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First Choice
traffic lightSelf
  • 0.3% drops 10ml
 
Hypromellose
(Ophthalmic drops Preservative Free)
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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)
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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)
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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)
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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
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Formulary
traffic lightSelf
  • Carmellose 0.5ml, glycerol 1%, castor oil 0.25% 10ml
 
 
Ciclosporin (Ikervis®)
(Ophthalmic drops)
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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)
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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%
(Ophthalmic drops)
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Formulary
traffic lightGreen
  • 0.9% drops
 
 
Sodium Chloride 0.9%
(Single use ophthalmic drops)
Formulary
traffic lightGreen
  • 0.9% 0.5ml Preservative-free
 
 
Sodium Chloride 5%
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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)
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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
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Formulary
traffic lightRed
  • 1% and 2% minims
  • Ophthalmic strips
  • GWH only
  • Non formulary at RUH and Salisbury
 
 
Ketorolac
(Drops)
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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)
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Formulary
traffic lightAmber
  • Salisbury only
  • Non formulary in BaNES and Swindon
 
 
Perflurodecaline (Heavy Liquid)
(Injection)
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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)
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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
 
 ....
 Non Formulary Items
Acetylcysteine 10% eye drops

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
 
Idebenone (Raxone®)

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 Alcohol
(Liquifilm Tears or Sno Tears®)

View adult BNF View SPC online
Non Formulary
 
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

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