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 Formulary Chapter 11: Eye - Full Chapter
Notes:

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.

Chapter Links...
 Details...
11.01  Administration of drugs to the eye
11.02  Control of microbial contamination
11.03  Anti-infective eye preparations
11.03.01  Antibacterials
Chloramphenicol 0.5% eye drops & ointment
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Preservative-free eye drops are also approved for use:
    • 0.5% preservative-free Minims® - first choice.
    • 0.5% preservative-free eye drops unlicensedunlicensed - approved only for patients who are unable to use Minims®due to dexterity problems

 
Azithromycin (Azyter®)
(ophthalmic)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Ciprofloxacin
View adult BNF View SPC online View childrens BNF
Formulary
Green

Eye drops: 0.3%
Eye ointment (preservative-free): 0.3%

 
 
Doxycycline
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

SR capsules 40 mg

Specialist indication: drug of choice for ocular rosacea

 
 
Hexamidine
View adult BNF View SPC online View childrens BNF
Formulary
Red

UNLICENSED

 
 
Levofloxacin
(ophthalmic)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Moxifloxacin
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Polihexanide
(eye drops)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Unlicensed

 
 
Vancomycin
(ophthalmic)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Fusidic Acid (Fucithalmic®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Gentamicin 0.3% ear/eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 1.5% eye drops with and with out preservative are also approved -  unlicensedunlicensed and Red Traffic Light
 
 
Ofloxacin 0.3% Eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Propamidine Isetionate
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • For use in the treatment of acanthamoeba keratitis – used with PHMB.
 
 
Benzylpenicillin 0.3% Eye drops
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
Cefuroxime 5% eye drops
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
Erythromycin 0.5% Eye ointment
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
Gentamicin 15mg/ml
(With preservative & preservative-free)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
Polyhexamethylene biguinide (PHMB) 0.02% Eye drops
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
Povidone iodine 5%
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
11.03.02  Antifungals to top
 note 

There are currently no licensed topical antifungal agents available for the treatment of eye infections. Products such as those below can be obtained as unlicensed medicines to meet specific needs on request from an ophthalmologist or microbiologist. Contact pharmacy at the RVI (0191 2825398) for details.

Chlorhexidine
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Amphotericin B Preservative-free
(eye drops)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • 0.1% and 0.3% eye drops.
 
 
Voriconazole
(eye drops)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • 100microgram in 0.1ml (0.1%) - preservative-free eye drops.
 
 
11.03.03  Antivirals
Aciclovir
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 3% eye ointment 
 
Ganciclovir  (Virgan®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 0.15% ophthalmic gel
 
Aciclovir
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 800mg Tablets
  • For the treatment of ophthalmic zoster.
 
 
Trifluorothymidine
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • 1% Eye drops
 
 
11.04  Corticosteroids and other anti-inflammatory preparations
11.04.01  Corticosteroids
Betamethasone 0.1% eye drops
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Dexamethasone 0.05%, framycetin sulf. 0.5%, gramicidin 0.005% eye drops (Sofradex)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Rimexolone
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

ophthalmology advice only - second line if flurometholone unsuitable

 
 
Betamethasone 0.1% with Neomycin 0.5% eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Dexamethasone 0.1% eye drops (Maxidex®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 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.

 
 
Dexamethasone 0.1% Preservative-free
View adult BNF View SPC online View childrens BNF
Alternatives
Green

First choice

Unit dose vials (Minims®)

Alternative

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

 
 
Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Eye drops and eye ointment
 
 
Fluorometholone 0.1% Eye drops (FML®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist.
 
 
Loteprednol Eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Approved as a second line agent to conventional corticosteroid eye drops, treatment to be imitated with the advice of an ophthalmologist only.
 
 
Prednisolone 0.5% Single Use Minims®
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Prednisolone eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 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.

 
 
Dexamethasone 700 microgram intravitreal implant (Ozurdex®)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
High Cost Medicine
  • 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
 
Fluocinolone 190 microgram intravitreal implant
View adult BNF View SPC online View childrens BNF
Alternatives
Red
High Cost Medicine
  • 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
  • Approved for treating chronic diabetic macular oedema in line with NICE

 

 
Link  NICE TA301: Fluocinolone 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
Link  NICE TA953: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema
 
11.04.02  Other anti-inflammatory preparations
Antazoline 0.5% with Xylometazoline 0.05% (Otrivine-Antistin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Ciclosporin 0.1% (1mg/1ml) Eye Drops
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Ikervis® - Approved for the treatment of dry eye disease in adults that has not improved despite treatment with artificial tears in line with NICE
  • Verkazia® - Approved for the treatment of severe vernal keratoconjunctivitis in children from 4 years of age and adolescents
 
Link  NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
 
Ketotifen (Zaditen®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

Ophthalmology advice - atopic keratoconjunctivitis

 
 
Olopatadine (Opatanol®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Sodium Cromoglicate 2% Eye drops
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • A 2% preservative free preparation is also approved unlicensedunlicensed -  treatment to be imitated with the advice of an ophthalmologist only.
 
 
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 40mg Injection
  • Approved for the treatment of children with Severe Refractory Uveitis in line with interim NHS England Clinical Commissioning Policy.
  • Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy (replaces interim policy for adalimumab for adults with severe refractory uveitis from 24th October 2017)
 
Link  Adalimumab and Infliximab for Children with Severe Refractory Uveitis
Link  NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis
 
Triamcinolone Acetonide (Intracinol®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

  • 40mg in 1ml ophthalmic suspension injection

    • Approved for use in patients with pre-operative diabetic macular oedema (DMA) and epiretinal membrane undergoing vitreoretinal surgery



 
 
11.05  Mydriatics and cycloplegics to top
Procaine hydrochloride, atropine sulphate & adrenaline acid tartrate (Mydricaine®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Mydricaine® No.2 [Contains procaine hydrochloride 6mg, atropine sulphate 1mg, adrenaline 1:1,000; (0.12mg)]
  • Approved for the treatment of anterior uveitis
 
 
11.05  Antimuscarinics
Atropine Sulphate Single Use Minims®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Cyclopentolate Eye drops
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 0.5% and 1%.
 
 
Cyclopentolate Single Use Minims®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 0.5% and 1%.
 
 
Cyclopentolate with phenylephrine
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Phenylephrine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 2.5% eye drops unlicensedunlicensed
  • 2.5% single use Minims®
 
 
Tropicamide single use Minims®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
11.05  Sympathomimetics
Phenylephrine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 2.5% eye drops unlicensedunlicensed.
  • 2.5% single use Minims®.
 
 
11.06  Treatment of glaucoma
11.06  Beta-blockers
Levobunolol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Eye drops: 0.5%
Unit dose eye drops: 0.5%

 
 
Timolol
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 0.25% and 0.5% eye drops.
    0.25% and 0.5% unit dose eye drops.
 
 
11.06  Prostaglandin analogues to top
Latanoprost eye drops
View adult BNF View SPC online View childrens BNF
First Choice
Green

  • 50 microgram/ml drops

  • 50 microgram/ml preservative free SDU (Monopost)

 
Travoprost
View adult BNF View SPC online View childrens BNF
Formulary
Green

Eye drops: 40 micrograms/1 mL

 
 
Travoprost with Timolol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Eye drops: travoprost 40 micrograms/1 mL, timolol 5 mg/1 mL (DuoTrav®)

 
 
Bimatoprost eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Bimatoprost with Timolol eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • For use as a second/third-line agent in patients insufficiently responsive
    to monotherapy with a prostaglandin analogue or beta blocker
 
 
Latanoprost 0.005% with Timolol 0.5% eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • For use as a second/third-line agent in patients insufficiently responsive
    to monotherapy with a prostaglandin analogue or beta blocker.
 
 
Tafluprost (Saflutan®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Tafluprost 15micrograms/ml eye drops

  • Tafluprost 15micrograms/ml eye drops 0.3ml unit dose preservative free

  • Reserved for patients who cannot tolerate other prostaglandin analogues
 
 
Tafluprost 15microg with timolol 0.5% eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
11.06  Sympathomimetics
Brimonidine Tartrate 0.2% eye drops
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
11.06  Carbonic anhydrase inhibitors and systemic drugs
Brinzolamide
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 1% eye drops.
 
Dorzolamide
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 2% eye drops.
  • 2% unit dose eye drops.
 
Brinzolamide 1% with Timolol 0.5%  (Azarga®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Brinzolamide 10mg/ml & brimonidine 2mg/ml (Simbrinza®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Approved as a third line agent as an “add-on” in patients at the very end of medical management.
 
 
Acetazolamide
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • second line carbonic anhydrase inhibitor for glaucoma
 
 
Dorzolomide 2% with Timolol 0.5%
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Eye drops and unit dose eye drops
  • Approved for use in patients with confirmed allergy presenting as
    conjunctival changes or skin allergy. To be initiated by ophthalmologists
    only. The ophthalmologists must clearly document that signs and
    symptoms of preservative allergy have been demonstrated in their
    patient prior to initiation.
 
 
11.06  Miotics
Pilocarpine
(eye drops)
View adult BNF View SPC online View childrens BNF
Third Choice
Green
  • 2% and 4% eye drops.
  • 1% and 2% unit dose eye drops.
 
 
11.07  Local anaesthetics
Controlled Drug Cocaine
View adult BNF View SPC online View childrens BNF
Formulary
Red

unlicensed P/F eye drops: 4%

 
 
Lidocaine 4% with Fluorescein 0.25% Minims®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Oxybuprocaine 0.4% Minims®
(Benoxinate)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Proxymetacaine 0.5% Minims®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Minims® eye drops (preservative free): 0.5%

 
 
Tetracaine 1% Minims®
(Amethocaine)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
11.08  Miscellaneous ophthalmic preparations to top
Mercaptamine hydrocholride
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Viscous eyedrops

    • Approved for the treatment of corneal cystine deposits in people aged 2 years and over in line with NHS England Clinical Commissioning Policy 



 
Link  Clinical Commissioning Policy Mercaptamine hydrochloride viscous eyedrops for corneal cystine deposits in people aged 2 years and over (210503P)
 
11.08.01  Tear deficiency, ocular lubricants, and astringents
Hypromellose
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 0.3% eye drops
  • 0.3% preservative-free eye drops:
    • 1st line Tear-Lac®;
    • 2nd line PF Drops® 
      • treatment to be initiated on the advice of ophthalmologist only
 
Artificial Tears Minims
View adult BNF View SPC online View childrens BNF
Formulary
Green

Hydroxyethylcellulose Artifical Tears Minims 4.4mg per mL Minims Eye Drops

 
 
Xailin Night
View adult BNF View SPC online View childrens BNF
Formulary
Green

White soft paraffin and mineral oil

 
 
Acetylcysteine 5% eye drops and preservative free eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
 
 
Acetylcysteine 5% with Hypromellose 0.35% (Ilube)
View adult BNF View SPC online View childrens BNF
Alternatives
Green

Eye drops: acetylcysteine 5%, hypromellose 0.35% (Ilube®)

 
 
Balanced Salt Solution
View adult BNF View SPC online View childrens BNF
Alternatives
Red
  • Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags.
  • For intra-ocular or topical irrigation during surgical procedures.
 
 
Carbomer 980 eye drops
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Viscotears® eye drops
  • GelTears® single unit dose eye drops
 
 
Carmellose sodium
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 0.5% and 1% eye drops.
 
 
Duolube® eye ointment
(Lanolin and preservative free)
View adult BNF View SPC online View childrens BNF
Alternatives

UNDER REVIEW

    • Please note
      The brand name will soon change to Sooth Night-time and Duolube will be unable to be ordered

 

 
 
Hylo Night®
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Eye ointment (containing retinol palmitate (vitamin A) 250iu/g, white soft paraffin, light liquid paraffin, liquid paraffin and wool fat)
 
 
Sodium Chloride
Alternatives
Green
  • 0.9% eye drops and single dose unit eye drops.
  • 5% eye drops and preservative-free eye drops.
  • 5% eye ointment unlicensedunlicensed.
 
 
Sodium Hyaluronate
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 0.1% eye drops & preservative-free eye drops
  • 0.2% eye drops & preservative-free eye drops
  • 0.4% unit dose vials (Clinitas) & 0.4% preservative-free eye drops (Clinitas Multi) 
 
 
Systane®
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 10ml multidose bottles 0.8ml preservative-free vials Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients).
  • Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. The multidose bottle may be used for up to six months after opening in primary care. In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.
 
 
11.08.02  Ocular diagnostic and peri-operative preparations and photodynamic treatment
11.08.02  Ocular diagnostic preparations
Fluorescein
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 2% minims eye drops
  • 1mg ophthalmic strips
  • Fluorets
  • 10% 5ml & 20% 5ml injections unlicensedunlicensed
 
 
Lissamine Green
View adult BNF View SPC online View childrens BNF
Formulary
Red
1.5mg ophthalmic strips 
 
Indocyanine green
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

25mg injection.

 
 
11.08.02  Ocular peri-operative drugs
Diclofenac
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 0.1% eye drops and unit dose eye drops.
  • For post-operative inflammation limited to patients where corticosteroids are unsuitable.
 
 
Acetylcholine Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 20mg in 2ml injection.
 
 
Apraclonidine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 0.5% and 1% ophthalmic solution.
 
 
Ketorolac (Acular®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 0.5% eye drops.
 
 
Nepafenac
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 1 mg/1mL eye drops
 
 
Povidone iodine 5% eye drops
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For use in eye surgery only. 
 
 
Sodium Hyaluronate
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 10mg in 1ml bag (Z-Hyalin®, formerly Ophthalin Gelbag®)
  • 14mg in 1ml syringe (Healon GV®)
 
 
Duovisc® Injection
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • Injection for use in cataract surgery containing VisCoat (1% sodium hyaluronate) and ProVisc (3% sodium hyaluronate, 4% chondroitin sulphate).
 
 
Ethanol 20% eye drops.
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For use in the debridement of the corneal epithelium in patients with
    recurrent corneal erosion syndrome.
 
 
11.08.02  Subfoveal choroidal neovascularisation to top
Aflibercept  (Eylea®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 40mg/1ml & 114.3mg/1ml solution for injection
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for macular oedema – central retinal vein occlusion in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE.
  • Approved as an option for treating visual impairment because of myopic choroidal neovascularisation in adults in line with NICE

 

 
Link  NICE TA 294 Aflibercept solution for injection for treating wet age‑related macular degeneration
Link  NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA 346 Aflibercept for treating diabetic macular oedema
Link  NICE TA 409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
Link  NICE TA 486: Aflibercept for treating choroidal neovascularisation
 
Brolucizumab (Beovu®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 19.8mg/0.165mL solution for injection (pre-filled syringes)
    • Approved for treating wet age-related macular degeneration in adults in line with NICE
 
Link  MHRA Drug Safety Update (Jan 2022): Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
Link  NICE TA672: Brolucizumab for treating wet age-related macular degeneration
Link  NICE TA820: Brolucizumab for treating diabetic macular oedema
 
Faricimab (Vabysmo® )
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
CCG
  • 120mg/1ml solution for injection
    • Approved for the treatment of diabetic macular oedema in adults in line with NICE
    • Approved for the treatment of wet age-related macular degeneration in line with NICE
 
Link  NICE TA799: Faricimab for treating diabetic macular oedema
Link  NICE TA800: Faricimab for treating wet age-related macular degeneration
 
Ranibizumab 10mg/1ml injection (Lucentis®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for visual impairment caused by macular oedema secondary
    to retinal vein occlusion in line with NICE.
  • Approved as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia in line with NICE.

 

 

 
Link  NICE TA 274 Ranibizumab for treating diabetic macular oedema
Link  NICE TA 155 Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA 283 Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA 298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
 
Verteporfin 15mg Injection (Visudyne®)
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Formulary
Red

Approved for photodynamic therapy in wet age-related macular degeneration in line NICE.

 
Link  NICE NG82: Age-related macular degeneration
Link  NTAG Decision Summary June 2020: Verteporfin
 
Bevacizumab 1.25mg/0.5ml intravitreal injection
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Unlicensed Drug Unlicensed
Red
CCG
  • NETAG approved for use in the management of macular oedema
    secondary to retinal vein occlusion. This is considered a more cost
    effective treatment option in RVO compared with ranibizumab.
  • NTAG approved for age related macular degeneration.

 

 
 
11.08.02  Vitreomacular traction
Ocriplasmin (Jetrea®)
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Formulary
Red
High Cost Medicine
  • Approved for use in patients with vitreomacular traction who also have no epiretinal membrane and a hole (up to 400 micrometres) in the centre of their retina or severe sight problems in line with NICE.
 
Link  NICE TA 297 Ocriplasmin for treating vitreomacular traction
 
11.08.02.04  Other products - Mainly for treating ocular injuries
11.08.02.04  Antifungals
11.08.02.04  Cytotoxics / wound healing modulators
11.08.02.04  Fibrinolytic drugs to top
11.08.02.04  Glues - ocular
11.08.02.04  Immunosuppressants
11.08.02.04  Treatment of burns
Holoclar®
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Formulary
Red
High Cost Medicine
  • Approved for treating limbal stem cell deficiency after eye burns in line with NICE and NHS England Commissioning Policy as of 14 November 2017
 
 
11.08.02.04  Visco-elastics
11.08.02.04  Other to top
Alteplase intravitreal injection
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Formulary
Red
 
 
Mydrane
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Formulary
Red

Intracameral injection: tropicamide 0.2 mg/mL, phenylephrine 3.1 mg/mL, lidocaine 10 mg/mL; 0.6 mL ampoules

 
 
Ascorbic acid 10% Preservative-free eye drops
(Potassium ascorbate)
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Unlicensed Drug Unlicensed
Red
 
 
Disodium edetate 0.37% solution
(20ml)
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Unlicensed Drug Unlicensed
Red
 
 
Sodium Citrate 10.11% eye drops
(equivalent to citrate 6.5%)
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Unlicensed Drug Unlicensed
Red
 
 
Tretinoin 0.05% eye drops
(Retinoic acid)
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Unlicensed Drug Unlicensed
Red
 
 
11.08.03  Reduction of elevated intra-ocular pressure
11.09  Contact lenses
 note 

Contact lenses are only provided on the NHS when there is a medical need. Usually this is when vision cannot be improved with spectacles, but can be improved with
contact lenses. The contact lens clinical staff at the RVI will assess eligibility. Examples of eligibility include some disorders of the cornea, very high prescriptions and
'bandage' lenses.

The following contact lens care products stocked for the care of contact lenses for patients attending the ophthalmology department at the RVI. GPs are not allowed to
prescribe contact lens solutions on the NHS.

Alcon Optifree® Express System
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Formulary
Red
 
 
Bausch & Lomb contact lens solution (Boston®)
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Formulary
Red
 
 
Bausch & Lomb saline (Salette®)
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Formulary
Red
 
 
Clens 100®
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Formulary
Red
 
 
Miraflow® daily cleaner
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Formulary
Red
 
 
Oxysept® 1 Step
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Formulary
Red
 
 
Systane®
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Formulary
Red
 
 
 ....
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
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary