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Airedale NHS Foundation Trust
Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 11: Eye - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand. 
 Details...
11.03.01  Antibacterials
Chloramphenicol  (Brochlor®, Chloromycetin®)
(Eye Drops)
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First Choice
Green
  • Chloramphenicol 0.5% Eye Drops (preservative free)
  • Chloramphenicol 1% Eye Ointment (with preservative)
  • Chloramphenicol 0.5% Minims (preservative free)

    Chloramphenicol has a broad spectrum of activity and is the drug of choice for superficial eye infections. Chloramphenicol eye drops are well tolerated and the recommendation that chloramphenicol eye drops should be avoided because of an increased risk of aplastic anaemia is not well founded.
 
Fusidic Acid
(Eye Drops)
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Second Choice
Green
  • Fusidic Acid 1% MR Eye Drops (with preservative)

    Fusidic acid is useful for staphylococcal infections.
 
Link  Antimicrobial Prescribing Guidance for Adults (ANHSFT access only)
   
Gentamicin  (Genticin®)
(Ear/Eye drops)
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Second Choice
Green
  • Gentamicin 0.3% Eye Drops (with preservative)
  • Gentamicin 0.3% Eye Drops (preservative free - unlicensed) - available for use in Bradford as specialist eye centre only

    Gentamicin is a broad spectrum antibiotic and is also effective for infections caused by Pseudomonas aeruginosa
 
   
Azithromycin (Azyter®)
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Restricted Drug Restricted
Green
  • Azithromycin eye drops single use 1.5%

      Available for use in Bradford as specialist eye centre only

 
   
Cefuroxime (ear drops)
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Restricted Drug Restricted
Red ULM
  • Cefuroxime (ear drops)

Unlicensed - prepared by aseptic unit

Available for use in Bradford as specialist eye centre only 

 
   
Ciprofloxacin  (Ciloxan®)
(Eye Drops)
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Restricted Drug Restricted
Amber
  • Ciprofloxacin 0.3% Eye Drops (with preservative)

    For Consultant Ophthalmologist recommendation only.
 
Link  DSU: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients
   
Levofloxacin  (Oftaquix®)
(Eye Drops)
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Restricted Drug Restricted
Amber
  • Levofloxacin 0.5% Eye Drops (with preservative)
  • Levofloxacin 5mg/ml Eye Drops (preservative free)

    For Consultant Ophthalmologist recommendation only for severe eye infections.
 
Link  DSU: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients
   
Ofloxacin Eye Drops (Exocin®)
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Formulary
Green
  • Ofloxacin Eye Drops 0.3%

      Available for use in Bradford as specialist eye centre only

 
   
11.03.02  Antifungals
 note 

Fungal infections of the cornea are rare but can occur after agricultural injuries, especially in hot and humid climates. Orbital mycosis is rarer, and when it occurs it is usually because of direct spread of infection from the paranasal sinuses. Increasing age, debility, or immunosuppression can encourage fungal proliferation. The spread of infection through blood occasionally produces metastatic endophthalmitis.

Many different fungi are capable of producing ocular infection; they can be identified by appropriate laboratory procedures.

Antifungal preparations for the eye are not generally available. Treatment will normally be carried out at specialist centres, but requests for information about supplies of preparations not available commercially should be addressed to the Strategic Health Authority (or equivalent), or to the nearest hospital ophthalmology unit, or to Moorfields Eye Hospital, 162 City Road, London EC1V 2PD (tel. (020) 7253 3411) or www.moorfields.nhs.uk.
(BNF April 2016)

Voriconazole (Ophthalmic solution)
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Restricted Drug Restricted
Red
  • Voriconazole Intravitreal injection
  • For use by opthalmologists only

       Available for use in Bradford as specialist eye centre only

 
   
11.03.03  Antivirals
Ganciclovir 0.15%  (Virgan®)
(Ophthalmic Gel)
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Formulary
Green
  • Ganciclovir Ophthalmic Gel
  • Following global discontinuation of aciclovir 3% eye ointment  due to repeated challenges in guaranteeing a sustainable product supply.
  • Clinical information on the switch and the licensing details (which differ from aciclovir) are available on the Ganciclovir eye gel SPC or on the switch memo from UKMi on the SPS website.
 
   
11.04  Corticosteroids and other anti-inflammatory preparations
11.04.01  Corticosteroids to top
 note 

Corticosteroids administered locally (as eye drops, eye ointments or subconjunctival injection) or by mouth have an important place in treating anterior segment inflammation, including that which results from surgery.

Topical corticosteroids should normally only be used under expert supervision; three main dangers are associated with their use:

  • a ‘red eye', where the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal and amoebic infections pose a similar hazard;
  • ‘steroid glaucoma' may follow the use of corticosteroid eye preparations in susceptible individuals;
  • a ‘steroid cataract' may follow prolonged use.

Other side-effects include thinning of the cornea and sclera.

Use of a combination product containing a corticosteroid with an anti-infective is rarely justified.

Betamethasone  (Betnesol®)
(Eye Ointment)
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Formulary
Amber
  • Betamethasone 0.1% Eye Ointment
 
   
Dexamethasone (Maxidex®, Dropodex®)
(Eye Drops)
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Formulary
Amber
  • Dexamethasone 0.1% Eye Drops (with preservative)
    Ensure Maxidex® brand is prescribed in primary care.

    Restricted Item Dexamethasone 0.1% Minims® (preservative free)
    For use in patients requiring a preservative free product only
 
   
Prednisolone
(Eye/Ear Drops)
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Formulary
Amber
  • Prednisolone 0.5% phosphate Eye/Ear Drops (with preservative)
  • Prednisolone 1% acetate Eye/Ear Drops (with preservative) Pred Forte®
     
     
    Restricted Item Prednisolone 0.5% phosphate Minims (preservative free)
    For use only in patients where a preservative free product is necessary.
    Other preservative-free strengths of prednisolone eye drops are non-formulary.
 
   
Betamethasone eye, ear and nose drops (Vistamethasone®)
(Eye)
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Formulary
Green
  • Betamethasone 0.1% eye, ear and nose drops

       (For the eye)

 
   
Dexamethasone with Antibacterials (Sofradex®)
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Formulary
Green
  • Dexamethasone drops (ear or eye)
  • Dexamethasone (as sodium metasulphobenzoate) 0.05%
  • Framycetin sulfate 0.5%
  • Gramicidin 0.005%

        Available for use in Bradford as specialist eye centre only

 
   
Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
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Formulary
Amber
  • Maxitrol Eye Drops (with preservative)
    (dexamethasone 0.1%, hypromellose 0.5%, neomycin sulphate 0.35%, polymyxin B sulphate 6000units/ml)
  • Maxitrol Eye ointment (with preservative)
    (dexamethasone 0.1%, neomycin sulphate 0.35%, polymyxin B sulphate 6000units/ml)
 
   
Fluocinolone intravitreal implant (Iluvien®)
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Restricted Drug Restricted
Red
  • Fluocinolone intravitreal implant

        Opthalmology use only

        Available for use in Bradford as specialist eye centre only

 
Link  NICE TA301:Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy (November 2013)
   
Betamethasone 0.1% with Neomycin 0.5%  (Betnesol N®)
(Eye Drops)
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Formulary
Amber
  • Betamethasone 0.1% Neomycin 0.5% Eye Drops (Betnesol N) (with preservative)
 
   
Fluorometholone  (FML®)
(Eye Drops)
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Formulary
Amber
  • Fluorometholone 0.1% Eye Drops (with preservative)
 
   
Loteprednol  (Lotemax®)
(Eye Drops)
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Restricted Drug Restricted
Amber
  • Loteprednol 0.5% (Lotemax) with preservative

    Treatment of post operative inflammation following ocular surgery.
 
   
Dexamethasone  (Ozurdex®)
(Intravitreal Implant)
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Restricted Drug Restricted
Red
  • Dexamethasone Intravitreal Implant

Supported for specialist use only in line with  NICE TA229 (macular oedema secondary to retinal vein occlusion)and TA349 (diabetic macular oedema).

 
Link  Letter: OZURDEX 700 micrograms intravitreal implant (dexamethasone) (March 2019)
Link  NICE TA229: Dexamethasone intravitreal implant for the treatment of macular oedema (July 2011)
Link  NICE TA349: Dexamethasone intravitreal implant for treating diabetic macular oedema (July 2015)
Link  NICE TA460:Adalimumab and dexamethasone for treating non-infectious uveitis (July 2017)
   
11.04.02  Other anti-inflammatory preparations
Sodium Cromoglicate  (Catacrom®, Cromolux®, Opticrom®, Optrex®, Pollenase)
(Eye Drops)
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First Choice
Green
  • Sodium Cromoglicate 2% Eye Drops (with preservative)

    Used for vernal keratoconjunctivitis and other allergic forms of conjunctivitis.
 
Olopatadine  (Opatanol®)
(Eye Drops)
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Second Choice
Green
  • Olopatadine 0.1% Eye Drops (with preservative)

    Useful as twice daily dosage
 
   
Lodoxamide  (Alomide®)
(Eye Drops)
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Second Choice
Green
  • Lodoxamide 0.1% Eye Drops (with preservative)
 
   
Nedocromil  (Rapitil®)
(Eye Drops)
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Second Choice
Green
  • Nedocromil 2% sodium Eye Drops (with preservative)
 
   
Azelastine  (Optilast®)
(Eye Drops)
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Second Choice
Green
  • Azelastine hydrochloride 0.05% Eye Drops (with preservative)
 
   
11.05  Mydriatics and cycloplegics
11.05  Antimuscarinics
 note 

Antimuscarinics dilate the pupil and paralyse the ciliary muscle; they vary in potency and duration of action.

  • Short-acting, relatively weak mydriatics, such as tropicamide 0.5% (action lasts for 4–6 hours), facilitate the examination of the fundus of the eye. Longer-acting options include cyclopentolate hydrochloride 1% (action up to 24 hours) or atropine sulfate (action up to 7 days).
  • Phenylepherine hydrochloride is used for mydriasis in diagnostic or therapeutic procedures; mydriasis occurs within 60–90 minutes and lasts up to 5–7 hours.
  • Mydriatics and cycloplegics are used in the treatment of anterior uveitis, usually as an adjunct to corticosteroids. Atropine sulfate is used in anterior uveitis mainly to prevent posterior synechiae and to relieve ciliary spasm; cyclopentolate hydrochloride can also be used and may be preferred because they have a shorter duration of action. (BNF April 2016)
  • Atropine Sulphate single use (Minims® Atropine Sulphate)
    (Single Use Eye Drops)
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    Formulary
    Green
    • Atropine 1% Minims (preservative free)
      For use in patients where a preservative free product is necessary or an individual dose is required
     
       
    Cyclopentolate Hydrochloride (Mydrilate®)
    (Eye Drops)
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    Formulary
    Green
    • Cyclopentolate 1% Eye Drops (with preservative)
    • Cyclopentolate 1% Minims (preservative free)
    • Cyclopentolate 0.5% Minims (preservative free)
      For use in patients where a preservative free product is necessary or an individual dose is required
     
       
    Tropicamide  (Mydriacyl®)
    (Eye Drops)
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    Formulary
    Green
    • Tropicamide 0.5% Eye Drops (with preservative)
    • Tropicamide 1% Eye Drops (with preservative)
    • Tropicamide 1% Minims (preservative free)
    • Tropicamide 0.5% Minims (preservative free)
      For use in patients where a preservative free product is necessary or an individual dose is required
     
       
    11.05  Sympathomimetics
    Phenylephrine Hydrochloride (Minims® Phenylephrine Hydrochloride )
    (Single Use Eye Drops)
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    Formulary
    Green
    • Phenylephrine 2.5%, 10% minims (preservative free)

      For use in patients where a preservative free product is necessary or an individual dose is required.
     
       
    11.06  Treatment of glaucoma to top
     note 

    Drugs that reduce intra-ocular pressure are used for managing glaucoma; they act by a variety of mechanisms. A topical beta-blocker or a prostaglandin analogue is commonly the drug of first choice. It may be necessary to combine these drugs or add others such as miotics, sympathomimetics and carbonic anhydrase inhibitors to control intra-ocular pressure.

    11.06  Beta-blockers
     note 

    Topical application of a beta-blocker to the eye reduces intra-ocular pressure effectively in primary open-angle glaucoma, probably by reducing the rate of production of aqueous humour. Administration by mouth also reduces intra-ocular pressure but this route is not used since side-effects may be troublesome.

    CAUTIONS, CONTRA-INDICATIONS AND SIDE-EFFECTS (See BNF).

    INTERACTIONS, Since systemic absorption may follow topical application the possibility of interactions, in particular, with drugs such as verapamil should be borne in mind. See also BNF Appendix 1 (beta-blockers).

    Timolol  (Timoptol®, Tiopex®)
    (Eye Drops)
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    Formulary
    Amber
    • Timolol Eye Drops 0.25% (with preservative)
    • Timolol 0.25% Single Dose Eye Drops (preservative free)

      For use following consultant recommendation only
     
       
    Betaxolol Hydrochloride (Betoptic®)
    (Eye Drops)
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    Formulary
    Amber
    • Betaxolol 0.5% and 0.25% Eye Drops (with preservative)
    • Betaxolol 0.25% Eye Drops Single dose M/R (preservative free)

      For use following consultant recommendation only
     
       
    Levobunolol Hydrochloride (Betagan®)
    (Eye Drops)
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    Formulary
    Amber
    • Levobunolol 0.5% Eye Drops (with preservative)
    • Levobunolol 0.5% Single Dose Eye Drops (preservative free)

      For use following consultant recommendation only
     
       
    11.06  Prostaglandin analogues
     note 

    Latanoprost, tafluprost and travoprost are prostaglandin analogues which increase uveoscleral outflow; bimatoprost is a related drug. They are used to reduce intra-ocular pressure in ocular hypertension or in open-angle glaucoma. Patients receiving prostaglandin analogues should be monitored for any changes to eye coloration since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only.

    Latanoprost  (Monopost®, Xalatan®)
    (Eye Drops)
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    First Choice
    Amber
    • Latanoprost 50micrograms/ml Eye Drops (with preservative)
    • Latanoprost 50micrograms/ml Eye Drops (preservative free)

      For use following consultant recommendation only
     
    Bimatoprost (Lumigan®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Bimatoprost Eye Drops (300micrograms/ml) (with preservative
    • Bimatoprost Eye Drops (300micrograms/ml) (with preservative
    • Bimatoprost Single Use Eye Drops (300micrograms/ml) (preservative free)

      For use following consultant recommendation only
     
       
    Tafluprost  (Saflutan®)
    (Single Use Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Tafluprost 15 microgram/mL Unit Dose Eye Drops (preservative free)

      For use following consultant recommendation only
     
       
    Travoprost (Travatan®)
    (Eye Drops)
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    Formulary
    Amber
    • Travoprost Eye Drops (40micrograms/ml) (2.5ml) (with preservative)

      For use following consultant recommendation only
     
       
    Bimatoprost with Timolol (Ganfort®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Bimatoprost 300micrograms/ml, timolol maleate 5mg/ml (with preservative)
    • Bimatoprost 300micrograms/ml, timolol maleate 5mg/ml (preservative free)

      For use following consultant recommendation only
     
       
    Travoprost with Timolol (DuoTrav®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Duotrav Eye Drops (travoprost 40micrograms/ml and timolol 5mg/ml) (with preservative)

      For use following consultant recommendation only
     
       
    Latanoprost with Timolol  (Xalacom®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Latanoprost 50micrograms/ml, Timolol 5mg/ml (with preservative)

      For use following consultant recommendation only
     
       
    11.06  Sympathomimetics
    Brimonidine Tartrate
    (Eye Drops)
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    Formulary
    Amber
    • Brimonidine 0.2% Eye Drops (with preservative)

      For use following consultant recommendation only
     
       
    Brimonidine Tartrate with Timolol  (Combigan®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Brimonidine 0.2% , Timolol 0.5%) (with preservative) Combigan Eye Drops

      For raised intra-ocular pressure in open angle glaucoma and for ocular hypertension when a beta-blocker alone is not adequate, apply twice a day.

      For use following consultant recommendation only
     
       
    11.06  Carbonic anhydrase inhibitors and systemic drugs
    Acetazolamide (Diamox®)
    (Tablets/Capsules)
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    Formulary
    Amber
    • Acetazolamide Tablets (250mg) (Diamox)
    • Acetazolamide MR Capsules (250mg) (Diamox SR)
      For use following consultant recommendation only
     
       
    Brinzolamide 1% with Timolol 0.5%  (Azarga®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Brinzolamide 1% with Timolol 0.5% Eye Drops (with preservative)

      For use following consultant recommendation only
     
       
    Brinzolamide® (Azopt)
    (Eye Drops)
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    Formulary
    Amber
    • Brinzolamide 10mg/ml Eye Drops (with preservative)

      For use following consultant recommendation only
     
       
    Dorzolomide
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Dorzolamide Unit Dose Eye Drops 2% (preservative free)

      For use following consultant recommendation only
     
       
    Dorzolomide 2% with Timolol 0.5% (Cosopt®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Dorzolamide hydrochloride 2%, timolol 0.5% (with preservative)
    • Dorzolamide hydrochloride 2%, timolol 0.5% (without preservative)

      For use following consultant recommendation only
     
       
    Acetazolamide
    (Injection)
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    Formulary
    Red
    • Acetazolamide Injection (500mg)
     
       
    11.06  Miotics to top
    Pilocarpine
    (Eye Drops)
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    Formulary
    Amber
    • Pilocarpine 2% Eye Drops (with preservative)
    • Pilocarpine Nitrate 2% Eye Drops Minims (preservative free)
       
     
       
    11.07  Local anaesthetics
     note  Local anaesthetics should never be used for the management of ocular symptoms
    Lidocaine Hydrochloride 4% with Fluorescein 0.25% (Minims®)
    (Single Use Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Lidocaine Hydrochloride 4% with Fluorescein 0.25%
     
       
    Oxybuprocaine Hydrochloride (Minims®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    • Oxybuprocaine HCL eye drops

           Available for use in Bradford as specialist eye centre only

     
       
    Proxymetacaine Hydrochloride (Minims®)
    (Single Use Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Proxymetacaine Hydrochloride (Preservative free)

      Proxymetacaine causes less initial stinging and is useful for children.
     
       
    Tetracaine
    (Single Use Eye Drops)
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    Formulary
    Green
    • Tetracaine (Amethocaine) 1% Minims (preservative free)

      Tetracaine produces a more profound anaesthesia and is suitable for before minor surgical procedures.
     
       
    11.08  Miscellaneous ophthalmic preparations
    11.08.01  Tear deficiency, ocular lubricants, and astringents
    Hypromellose
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Hypromellose is the first choice treatment for tear deficiency. It may need to be instilled frequently (e.g. hourly) for adequate relief.

    • Hypromellose 0.3% Eye Drops (with preservative)
    • Xailin Hydrate® hypromellose 0.3% Eye Drops (preservative free)
     
    Carmellose Sodium
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green
    • Carmellose Sodium 0.5% Single Dose Eye Drops (preservative free) Xailin Fresh® 
    • Carmellose sodium  1% Single Dose Eye Drops (preservative free)
    • Carmellose Sodium 0.5% Eye Drops (with preservative).
     
       
    Sodium Hyaluronate (Hyloforte®, Hylotear®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Third Choice
    Amber
    • Sodium Hyaluronate 0.2% Eye Drops (preservative free) (Hyloforte®)
    • Sodium Hyaluronate 0.1% Eye Drops (preservative free) (Hylotear®)

    Hyloforte® and Hylotear® are the preferred preparation, and can be used for up to six months after opening. Contains 300 applications.

    • Sodium Hyaluronate 0.2% unit dose vials are available if required (Blink Intensive Tears)

    Restricted Item Sodium hyaluronate 0.4% (preservative free) (Clinitas®)
    Restricted Item Sodium Hyaluronate 0.1%, carmellose sodium 0.5%, glycerol 0.9% Eye Drops (Optive Fusion®)

    Restricted to Consultant Ophthalmologist recommendation only.

     
       
    Hylo Night®
    (Eye Ointment)
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    Fourth Choice
    Green
    • Hylo Night ointment® (250IU/g) retinol palmitate, liquid paraffin, light liquid paraffin, wool fat and white soft paraffin (preservative free)

      Eye ointments containing a paraffin may be used to lubricate the eye surface, especially in cases of recurrent corneal epithelial erosion. They may cause temporary vision disturbance and are best suited for application before sleep. Ointments should not be used during contact lens wear.
     
       
    Liquid Paraffin
    (Eye Ointment)
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    Fourth Choice
    Green
    • Xailin Night® Eye Ointment (preservative free)
      (white soft paraffin 57.3%, liquid paraffin 42.5%, wool alcohols 0.2%)

      Eye ointments containing a paraffin may be used to lubricate the eye surface, especially in cases of recurrent corneal epithelial erosion. They may cause temporary vision disturbance and are best suited for application before sleep. Ointments should not be used during contact lens wear.
     
       
    Polyvinyl Alchohol (SnoTears®, Liquifilm tears ®)
    (Eye Drops)
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    Formulary
    Green
    • Polyvinyl Alchohol (with preservative) SnoTears® 
    • Polyvinyl Alchohol (preservative free) Liquifilm tears® 

      Polyvinyl alcohol increases the persistence of the tear film and is useful when the ocular surface mucin is reduced.
     
       
    Carbomer 980 (Clinitas Gel®, Viscotears®)
    (Eye Gel)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Carbomer 980 Eye Gel - Clinitas®    
    • Carbomer 980 Liquid Gel - Viscotears®
    • Liquid Gel  Single Dose Unit Eye Gel - Viscotears®)
     
       
    Acetylcysteine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    • Acetylcysteine drops

           Available for use in Bradford as specialist eye centre only

     
       
    Acetylcysteine 5% with Hypromellose 0.35% (Ilube®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Acetylcysteine 5% with Hypromellose 0.35% (with preservative)

      Consultant Ophthalmologist recommendation only - For existing patients only.
     
       
    Hydroxyethylcellulose (Minims® Artificial Tears)
    (Single Use Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Hydroxyethylcellulose 0.44%, Sodium Chloride 0.35% Single Dose Eye Drops (Minims Artificial Tears) 

      For use following consultant recommendation only, in patients where a preservative free product is necessary
     
       
    Hydroxypropyl Guar (Systane Balance®, Systane Ultra ®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Hydroxypropyl (with preservative) GuarSystane Balance® 
    • Hydroxypropyl (with preservative) GuarSystane Ultra®

      For Consultant Ophthamologist Recommendation Only
     
       
    Sodium Chloride
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Sodium Chloride 5% Eye Drops
    • Sodium Chloride 0.9% Eye Drops Minims (preservative free)
    • Sodium chloride 0.9% (Minims) Restricted to consultant ophthalmologist recommendation only.

     

     

     
       
    Sodium Chloride
    (Balanced Salt Solution)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Sodium Chloride Balanced Salt Solution
       
      For use in eye theatre only
     
       
    Viscoat
    (Solution)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Viscoat Solution (0.75ml)

      For use in eye theatre only
     
       
    11.08.02  Ocular diagnostic and peri-operative preparations and photodynamic treatment
    VibeX Rapid (Riboflavin 0.1%)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • VibeX Rapid (Riboflavin 0.1%) 1.5mL prefilled syringe
    • Restricted to use by opthalmic surgeons for ‘epithelium-off’ photochemical corneal collagen cross-linkage (epithelium-off CXL) to treat progressive keratoconus or keratectasia after laser refractive surgery.

            Available for use in Bradford as specialist eye centre only

     
    Link  NICE IPG466: Photochemical corneal collagen cross‑linkage using riboflavin and ultraviolet A for keratoconus and keratectasia (September 2013)
       
    11.08.02  Ocular diagnostic preparations to top
    Fluorescein Sodium (Minims®)
    (Single Use Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Fluorescein Sodium 2% Minims (preservative free)
       
     
       
    11.08.02  Ocular peri-operative drugs
     note 

    Drugs used to prepare the eye for surgery and drugs that are injected into the anterior chamber at the time of surgery are included here.

    Apraclonidine  (Iopidine®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Apraclonidine 1% Eye Drops (24 X 0.25ml) (preservative free)

      For use following consultant recommendation only
     
       
    Diclofenac Sodium  (Voltarol®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Diclofenac Sodium 0.1% Eye Drops (with preservative)
    • Diclofenac Sodium 0.1% Single Dose Eye Drops (preservative free)

      For use following consultant recommendation only
     
       
    Ketorolac 0.5%  (Acular®)
    (Eye Drops)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Ketorolac 0.5% Eye Drops (5ml) with preservative

      For use following consultant recommendation only
     
       
    Cefuroxime (Aprokam®)
    (Intracameral Injection)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Cefuroxime 50mg Injection (for intracameral use)
       
      For Eye theatre use only.
     
       
    Sodium hyaluronate  (Provisc®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Sodium hyaluronate (Provisc®) is used during surgical procedures on the eye.
     
       
    Vision Blue
    (Solution)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Vision Blue 0.5ml Solution

      For Eye Theatre use only.
     
       
    11.08.02  Subfoveal choroidal neovascularisation
    Aflibercept (Eylea®)
    (Solution for Injection)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    • Aflibercept Solution for Injection

    Approved for use in line with NICE guidance:

    • NICE TA294 (wet age-related macular degeneration)
    • NICE TA305 (macula oedema secondary to central retinal vein occlusion)
    • NICE TA307 - NOT RECOMMENDED (metastatic colorectal cancer)
    • NICE TA346 (diabetic macular oedema)
    • NICE TA409 (macula oedema after branch retinal vein occlusion)

      Restricted to Consultant Ophthalmologist use only.
     
    Link  Aflibercept - Information on the risk of osteonecrosis of the jaw (March 2016)
    Link  NICE TA294: Aflibercept solution for injection for treating wet age‑related macular degeneration (July 2013)
    Link  NICE TA305: Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion (February 2014)
    Link  NICE TA307: Aflibercept in combination with irinotecan and fluorouracil-based therapy for treating metastatic colorectal cancer that has progressed following prior oxaliplatin-based chemotherapy (March 2014)
    Link  NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion (September 2016)
    Link  NICE TA486: Aflibercept for treating choroidal neovascularisation (November 2017)
    Link  TA346: Aflibercept for treating diabetic macular oedema (July 2015)
       
    Bevacizumab intravitreal injection (Avastin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    • Bevacizumab intravitreal injection

           Available for use in Bradford as specialist eye centre only

     
       
    Ranibizumab (Lucentis®)
    (Intravitreal Injection )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    • Ranibizumab Solution for Intravitreal Injection 10mg/mL
      0.23mL

      For Consultant Opthalmologist use only.
      Use supported for the treatment of wet age-related macular degeneration in-line with NICE TA155
     
    Link  NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration (May 2012)
    Link  NICE TA237: Ranibizumab for the treatment of diabetic macular oedema (Nov 2011)
       
    11.09  Contact lenses
    11.99.99.99  Miscellaneous
    11.99.99.99  Antifungals to top
    11.99.99.99  Cytotoxics / wound healing modulators
    Fluorouracil
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red ULM
    • Fluorouracil Intravitreal Injection
      Unlicensed - prepared by aseptic unit

             Available for use in Bradford as specialist eye

     
       
    Mitomycin C
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red ULM
    • Mitomycin Intravitreal Injection
      Unlicensed - prepared by aseptic unit

             Available for use in Bradford as specialist eye

     
       
    11.99.99.99  Fibrinolytic drugs
    Alteplase intravitreal injection
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Alteplase intravitreal injection 25microgram in 0.1mL

           Available for use in Bradford as specialist eye centre only

     
       
    11.99.99.99  Glues - ocular
    11.99.99.99  Immunosuppressants
    Ciclosporin 0.1% (Ikervis®)
    (Eye Drops )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Ciclosporin 0.1% Eye Drops 

    For consultant ophthalmologist initiation and monitoring in line with NICE TA369.

     
    Link  NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears (Dec 2015)
       
    Ciclosporin 0.1% eye drops (Verkazia®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    • Ciclosporin 0.3ml unit dose eye drops

              Paediatric opthalmology use only

              Available for use in Bradford as specialist eye centre only

     
       
    11.99.99.99  Treatment of burns to top
    11.99.99.99  Visco-elastics
    11.99.99.99  Other
     ....
     Non Formulary Items
    Lutein and Antioxidants

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Not for routine prescribing in primary care in line with NHSE recommendation.

    Link  NHSE: Items which should not routinely be prescribed in primary care: Guidance for CCGs (2017)
     
    Oral Eye Health Vitamins

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Not for routine prescribing in primary care in line with NHSE recommendation.

    Link  NHSE: Items which should not routinely be prescribed in primary care: Guidance for CCGs (2017)
     
      
    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 children's BNF
    click to search medicines.org.uk
    Link to SPCs
    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

    Traffic Light Status Information

    Status Description

    Green

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following 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.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

    netFormulary