Formulary


	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...

11.08.01

Tear deficiency, ocular lubricants, and astringents

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%)

First Choice

0.3% drops 10ml

Hypromellose
(Ophthalmic drops Preservative Free)

First Choice

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)

First Choice

0.2% gel 10g

Carbomer 980 eye drops
(Ophthalmic liquid gel)

First Choice

0.2% gel 10g
Suitable for contact lense wearers

Carmellose
(Ophthalmic drops)

First Choice

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)

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.

Acetylcysteine
(Ophthalmic drops)

Formulary

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

Formulary

Carmellose 0.5ml, glycerol 1%, castor oil 0.25% 10ml

Ciclosporin (Ikervis^®)
(Ophthalmic drops)

Formulary

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

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)

Formulary

GWH for recurrent erosions only. Not on formulary at RUH/SFT
Consider Hylo-night (formerly VitA-POS or Hydramed night)

Propylene glycol
(Ophthalmic drops)

Formulary

10ml

Propylene glycol 0.3% and polyethlene glycol 0.4% with hydroxypropyl guar
(Ophthalmic drops)

Formulary

10ml

Retinol palmitate with soft paraffins

Formulary

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

Eye irrigation solutions 19ml, 500ml

Sodium Chloride 0.9%
(Single use ophthalmic drops)

Formulary

0.9% 0.5ml Preservative-free

Sodium Chloride 0.9%
(Ophthalmic drops)

Formulary

0.9% drops

Sodium Chloride 5%

Formulary

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)

Formulary

0.1% Preservative-free (VisuXL^®)
2 month expiry
Specialist initiation only in line with BSW dry eye guidance

Ciclosporin
(Ophthalmic ointment)

Unlicensed

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

For use within GWH only

....

Non Formulary Items

Acetylcysteine 10% eye drops

Non Formulary

Hydroxyethylcellulose
(Minims^® Artificial Tears)

Non Formulary

Optive ^® Fusion

Non Formulary

Paraffin Yellow Soft
(Simple eye ointment)

Non Formulary

Polyvinyl Alcohol
(Liquifilm Tears or Sno Tears^®)

Non Formulary

Soybean oil unit dose eye drops
(Emustil^®)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	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.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(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.
	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.