North East and North Cumbria
ICS Formulary
 
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11 Eye

Preservative Free Eye Drops
Microbial contamination of multidose bottles of eye drops can cause eye infections that may lead to damage of the eye and in extreme cases loss of sight. To minimise the risk, multidose bottles of eye drops contain an antimicrobial preservative such as benzalkonium chloride. The preservatives used in eye drops are normally well tolerated, but they are not completely harmless. They can cause irritation and damage to the corneal epithelium. This risk is understood to be greater in patients with pre-existing damage to the ocular surface and where large quantities of preservative containing eye drops are applied repeatedly over a prolonged period (e.g. if applied more than 4 to 6 times daily for several weeks/ months).
To avoid these problems the use of preservative-free eye drops is recommended in:
 Patients who have experienced hypersensitivity reactions or irritation due to preservatives in eye drops.
 Patients who have received corneal grafts.
 Patients with conditions where there is already damage to the ocular surface as a result of disease or trauma, such as dry eye, blepharitis, ocular burns etc.
Treatment with preservative-free eye drops will usually be initiated by an ophthalmologist.

11-04-01 Corticosteroids

Betamethasone 0.1% eye drops
First Choice

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Dexamethasone 0.05%, framycetin sulf. 0.5%, gramicidin 0.005% eye drops Sofradex
Formulary

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Rimexolone
Formulary

ophthalmology advice only - second line if flurometholone unsuitable


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Betamethasone 0.1% with Neomycin 0.5% eye drops
Formulary

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Dexamethasone 0.1% eye drops Maxidex®
Formulary
  • Preservative-free eye drops are also approved.
    • 0.1% Minims® - first choice.
    • 0.1% preservative free eye drops unlicensedunlicensed - approved only for patients who are unable to use Minims®due to dexterity problems.


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Dexamethasone 0.1% Preservative-free
Formulary

First choice

Unit dose vials (Minims®)

Alternative

Eye drops (unlicensed) - only for patients who are unable to use Minims® due to dexterity problems


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Dexamethasone with Neomycin and Polymyxin B sulphate Maxitrol®
Formulary
  • Eye drops and eye ointment

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Fluorometholone 0.1% Eye drops FML®
Formulary
  • For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist.

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Loteprednol Eye drops
Formulary
  • Approved as a second line agent to conventional corticosteroid eye drops, treatment to be imitated with the advice of an ophthalmologist only.

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Prednisolone 0.5% Single Use Minims®
Formulary

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Prednisolone eye drops
Formulary
  • The following formulations are approved
    • 0.5% eye drops and 1% (Pred-Forte).
    • 0.1% and 0.3% eye drops - both unlicensedunlicensed.

  • Approved preservative free formulations include
    • 0.5% minims.
    • 0.1%, 0.3%, 0.5% and 1% - all unlicensedunlicensed.


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Dexamethasone 700 microgram intravitreal implant Ozurdex®
Formulary
  • Approved for macular oedema following central retinal vein occlusion
    in line with NICE.
  • Approved for treating diabetic macular oedema in line with NICE.
  • Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy

 

Note: The Northern (NHS) Treatment Advisory Group recommends the sequential pharmacological management of MO secondary to RVO as per the North East Retina Group (NERG) RVO treatment pathway.

Link  NICE TA229 Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion
Link  NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis
Link  NICE TA824: Dexamethasone intravitreal implant for treating diabetic macular oedema

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Fluocinolone 190 microgram intravitreal implant
Formulary

  • Recommended as a possible treatment for people with chronic diabetic macular oedema who have an artificial lens in their eye if the implant is used in the eye with the artificial lens and their diabetic macular oedema has not got better with other treatments - in line with NICE.

  • Approved for the treatment of recurrent non-infectious uveitis in line with NICE

  • Approved for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy in line with NICE

Link  NICE TA301Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
Link  NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
Link  NICE TA613: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy

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