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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...
11.08.01  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)
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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
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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%
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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)
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

 

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

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

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
 
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
 
  
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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