Section 11: Eye

Section Description

Administering Eye Drops

Administering Eye Drops

BNF 11.3.1

Antibacterials

BNF 11.3.2

Antifungals

BNF 11.3.3

Antivirals

BNF 11.4.1

Corticosteroids

BNF 11.4.2

Other anti-inflammatory preparations

BNF 11.5

Mydriatics and cycloplegics

BNF 11.6

Treatment of glaucoma

BNF 11.7

Local anaesthetics

BNF 11.8.1

Tear deficiency, ocular lubricants, and astringents

BNF 11.8.2

Ocular diagnostic and peri-operative preparations and photodynamic treatment

Administering Eye Drops

BNF 11.3.1 Antibacterials

Superficial eye infections

 

Chloramphenicol

Single use product (Minims®) available

Ciprofloxacin Used with specialist direction

Gentamicin

 

Levofloxacin

 

Levofloxacin preservative-free

Unit dose

Ofloxacin Used with specialist direction

BNF 11.3.2 Antifungals

Only available as specials

BNF 11.3.3 Antivirals

Aciclovir (Acyclovir)

Eye Ointment

BNF 11.4.1 Corticosteroids

Topical corticosteroids should normally only be used under expert supervision as there are dangers associated with their use.

Betamethasone 0.1%

Betnesol®
Vista-Methasone®

Dexamethasone 0.1%

Maxidex®
Single use product (Minims®) available.

Dexamethasone intravitreal injection 

Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion NICE TA229

Dexamethasone intravitreal implant for treating diabetic macular oedema NICE TA349

Fluocinolone acetonide intravitreal injection Diabetic macular oedema - Fluocinolone acetonide intravitreal implant NICE TA301

Fluorometholone 0.1%

FML®

Loteprednol etabonate Treatment of post-operative inflammation following ocular surgery

Prednisolone 0.5%

Single use product (Minims®) available

Prednisolone 1%

Pred Forte®

BNF 11.4.2 Other anti-inflammatory preparations


ALLERGIC CONJUNCTIVITIS

 

 

First choice

Sodium cromoglicate eye drops 2%
(Sodium cromoglycate)

 

 

Second choice

Azelastine eye drops 0.05%

 

Optilast®

 

Antazoline sulphate 0.5% + xylometazoline 0.05% eye drops

 

Otrivine Antistin®

Lodoxamide 0.1% eye drops

 

Alomide®

 

Olapatadine 1mg/ml eye drops

 

For initiation by opthalmologists for the treatment of seasonal allergic conjunctivitis.  Opatanol®

Adalimumab

Hospital Only

Adalimumab and dexamethasone for treating non-infectious uveitis  NICE TA460

 

Ciclosporin

Ciclosporin (Ikervis®) treatment must be initiated by an ophthalmologist or a healthcare professional qualified in ophthalmology. The recommended dose is one drop of Ikervis® once daily to be applied to the affected eye(s) at bedtime. Response to treatment should be reassessed at least every 6 months.  NICE TA369

BNF 11.5 Mydriatics and cycloplegics

Antimuscarinics

 

 

Atropine sulphate

25p

Refraction procedures

Cyclopentolate

25p

 

Tropicamide 0.5% & 1%

29p

Facilitates examination of fundus
Only available as single use product (Minims®)

Sympathomimetics

 

 

Phenylephrine

29p

Only available as single use product (Minims®)

BNF 11.6 Treatment of glaucoma

BETA-BLOCKERS

The CSM has advised that beta-blockers, even those with apparent cardioselectivity, should not be used in patients with asthma or a history of obstructive airways disease, unless no alternative treatment is available.

Betaxolol

Betoptic®

Levobunolol

Betagan®

Timolol

Timoptol®
Timoptol LA®
Also available as preservative-free eye drops

PROSTAGLANDIN ANALOGUES

Latanoprost

Xalatan®
Monoprost® preservative-free - recommendation of ophthalmologist

2nd line  

Bimatoprost

Lumigan®
Lumigan® single use - recommendation of ophthalmologist

3rd line  

Travoprost

Travatan®

Tafluprost Preservative-free preparation

SYMPATHOMIMETICS

Brimonidine

Alphagan®

CARBONIC ANHYDRASE INHIBITORS AND SYSTEMIC DRUGS

Acetazolamide (oral)

 

Acetazolamide (injection)

 

Brinzolamide

Azopt®

Brinzolamide + brimonidine Simbrinza®

Dorzolamide

Trusopt®

MIOTICS

 

Pilocarpine

 

Single use (Minims®) 2% & 4% eye drops
Pilogel®

BETA-BLOCKER plus ……

 

Timolol

brimonidine

Combigan®

Timolol

dorzolamide

Cosopt®

Timolol

latanoprost

Xalacom®

2nd line (for initiation by New Cross Hospital Opthalmologists)

Timolol

bimatoprost

Ganfort®

Timolol tafluprost Taptiqom®

Timolol

brinzolamide

Azarga®

3rd line      

Timolol

travoprost

 

DuoTrav®

BNF 11.7 Local anaesthetics

Oxybuprocaine single dose

 

Benoxinate Minims®

Tetracaine (Amethocaine) single-dose

 

Amethocaine hydrochloride minims®

1st Line

 

 

Proxymetacaine and fluorescein single dose

 

Minims®

2nd Line

 

 

Lidocaine and Fluorescein single dose

 

Minims®

BNF 11.8.1 Tear deficiency, ocular lubricants, and astringents

Printable copy of local guidelines for the treatment of dry eyes

 

Severity

First choice treatment If first choice is not appropriate (second choice) Other treatments
PF= preservative-free, 6M = 6 month expiry when once opened, C = suitable for use with contact lenses
Mild dry eyes
(less than 4 drops per day needed)

Hypromellose drops 0.5% or 0.3%(interchangeable)10ml

Carbomer 980 gel 10g (Clinitas® gel)

Drops used four times a day or less Optive® 10ml (carmellose) - multidose PF/6M/C.

Drops used more than four times a day
Acetylcysteine 5% (Ilube® 10ml)
Carmellose 1% unit dose (Pack of 30) PF/C

Bed time: Xailin night® 5g

Moderate dry eyes
(4 to 6 drops per day needed)

Hypromellose drops 0.5% or 0.3%(interchangeable)10ml
Carbomer 980 gel 10g (Clinitas® gel)

A preservative free drop may be given if drops are used 6 times a day or more along with Xailin night® used at night time.

Drops used four times a day or less Optive® 10ml (carmelose) - multidose PF/6M/C.

Drops used more than four times a day
Acetylcysteine 5% (Ilube® 10ml)
Carmellose 1% unit dose (Pack of 30) PF/C 
if not tolerated, carmellose 0.5% (Xailin fresh®) PF/C

Bed time: Xailin night® 5g 

Severe dry eyes
(more than 6 drops per day needed)

Initiated by a specialist consultant
Evolve® drops 10ml - multidose/PF/6M/C
Optive® 10ml (carmellose) - multidose /PF/6M/C
Acetylcysteine 5% (Ilube® 10ml)
Carmellose 1% unit dose (Pack of 30) PF/C 
if not tolerated, carmellose 0.5% (Xailin fresh®) PF/C  
Bed time: Xailin night® 5g 

BNF 11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment


OCULAR DIAGNOSTIC PREPARATIONS

Fluorescein sodium eye drops

Single dose - Minims®

Rose Bengal eye drops

Single dose - Minims®

OCULAR PERI-OPERATIVE DRUGS

Acetylcholine chloride

 

Apraclonidine eye drops 0.5% & 1%

 

Bromfenac Postoperative inflammation following cataract surgery

Cefuroxime intracameral injection

Unlicensed use

Diclofenac sodium eye drops 0.1%

 

Flurbiprofen sodium solution 0.03%  

Ketorolac eye drops 0.5%

 

Subfoveal choroidal neovascularistaion  
Aflibercept

Aflibercept solution for injection for treating wet age-related macular degeneration NICE TA294

Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion NICE TA305

Aflibercept for treating diabetic macular oedema NICE TA346 

Aflflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion NICE TA409 

Aflibercept for treating choroidal neovascularisation NICE TA486 

Ranibizumab injection

Lucentis®. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration NICE TA155 

Ranibizumab for treating diabetic macular oedema NICE TA274 (replacing NICE TA237)

Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion NICE TA283

Ranibizumab for treating choroidal neovascularisation associated with pathological myopia NICE TA298

Vitreomacular traction
Ocriplasmin Ocriplasmin for treating vitreomacular traction NICE TA297