| Formulary Chapter 11: Eye - Full Chapter
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| 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. |
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| Chapter Links... |
 NICE NG242 : Diabetic retinopathy: management and monitoring |
 North of Tyne, Gateshead and North Cumbria - Ophthalmology Referral Guidelines |
| Details... |
| 11.08.01 |
Tear deficiency, ocular lubricants, and astringents |
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Hypromellose
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First Choice
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- 0.3% eye drops
- 1st choice – AacuLose or AaproMel
- 2nd choice – Ocufresh
- 0.3% preservative-free eye drops:
- 1st choice – Evolve
- 2nd choice – AddTear
- 3rd choice – Tear-Lac
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Acetylcysteine 5% eye drops and preservative free eye drops
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Alternatives
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Acetylcysteine 5% with Hypromellose 0.35% (Ilube)
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Alternatives
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Eye drops: acetylcysteine 5%, hypromellose 0.35% (Ilube®)
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Balanced Salt Solution
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Alternatives
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- 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.
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Carbomer 980
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Alternatives
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- Carbomer 980 0.2% eye gel (joint first choice options)
- Ocufresh carbomer
- Clinitas Carbomer
- Lumecare
- Carbomer '980' 0.2% eye gel preservative free
- Evolve Carbomer 980 (1st choice)
- Viscotears 0.2% eye gel 0.6ml unit dose (2nd choice, Only if unit doses required)
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Carmellose sodium
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Alternatives
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- Carmellose 0.5% eye drops
- 1st choice AaqEye Carmellose or Aqualube
- 2nd choice Optho-Lique 0.5%
- Carmellose 0.5% eye drops preservative free
- Ocufresh comfort 0.5% (1st choice)
- VIZcellose 0.5% (2nd choice)
- Cellusan Light 0.5% (3rd choice)
- Carmellose 0.5% eye drops 0.4ml unit dose preservative free (ONLY if unit dose required)
- Lumecare singles carmellose 0.5% (1st choice)
- Xailin fresh 0.5% carmellose (2nd choice)
- Carmellose 1% eye drops
- Aqualube Forte 1% (1st choice)
- Optho-Lique Forte 1% (2nd choice)
- Carmellose 1% eye drops preservative free
- Ocufresh comfort plus (1st choice)
- Eyeaze Carmellose 1% (1st choice)
- VIZcellose 1% (2nd choice)
- Carmellose 1% eye drops 0.4ml unit dose preservative free (ONLY if unit dose required)
- Cellusan 1% eye drops 0.4ml
- Celluvisc 1% eye drops 0.4ml
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Duolube® eye ointment
(Lanolin and preservative free)
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Alternatives
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UNDER REVIEW
- Please note
The brand name will soon change to Sooth Night-time and Duolube will be unable to be ordered
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HydraMed night eye ointment preservative free®
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Alternatives
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HydraMed Night Sensitive®
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Alternatives
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Hylo Night®
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Alternatives
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- Eye ointment (containing retinol palmitate (vitamin A) 250iu/g, white soft paraffin, light liquid paraffin, liquid paraffin and wool fat)
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Moistueyes®
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Alternatives
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Sodium Chloride
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Alternatives
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- Sodium chloride 0.9% eye drops 0.5ml unit dose preservative free
- AddLube Sodium Chloride 0.9% eye drops 0.5ml (1st choice)
- Minims saline 0.9% eye drops 0.5ml (2nd choice)
- Sodium chloride 5% eye drops
- AabChlor Sodium Chloride 5% (1st choice)
- Sodium chloride 5% eye drops preservative free
- SodiEye 5% preservative free (1st choice)
- Aeon 5% preservative free (2nd choice)
- Sodium chloride 5% eye drops 0.5ml unit dose preservative free (ONLY if unit dose required)
- SodiEye 5% eye drops 0.5ml (1st choice)
- 5% eye ointment
 unlicensed.
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Sodium Hyaluronate
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Alternatives
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- Sodium hyaluronate 0.1% eye drops
- Aactive 0.1% (1st choice)
- AaqEye HA 0.1% eye drops (1st choice)
- Sodium hyaluronate 0.1% eye drops preservative free
- VIZhyal 0.1% PF (1st choice)
- ClinOptic HA 0.1% preservative free (1st choice)
- Hylo-Tear 0.1% preservative free (2nd choice)
- Sodium hyaluronate 0.2% eye drops
- Blink Intensive Tears 0.2% (1st choice)
- AaqEye HA 0.2% (2nd choice)
- Sodium hyaluronate 0.2% eye drops preservative free
- VIZhyal 0.2% preservative free (1st choice)
- ClinOptic HA 0.21% preservative free (1st choice)
- Hylo-Forte 0.2% preservative free (2nd choice)
- Sodium hyaluronate 0.2% eye drops 0.5ml unit dose preservative free (ONLY if unit dose required)
- Clinitas 0.2% 0.5ml unit dose preservative free (1st choice)
- HydraMed 0.2% 0.5ml unit dose preservative free (1st choice)
- Sodium hyaluronate 0.4% eye drops preservative free
- VIZhyal 0.4% preservative free (1st choice)
- HydraMed Forte 0.4% preservative free (2nd choice)
- Clinitas Multi 0.4% preservative free (3rd choice)
- Sodium hyaluronate 0.4% eye drops 0.5ml unit dose preservative free (ONLY if unit dose required)
- Clinitas 0.4% 0.5ml unit dose preservative free (1st choice)
- HydraMed Forte 0.4% 0.5ml unit dose preservative free (1st choice)
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Systane®
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Alternatives
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- 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.
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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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. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic.
The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible.
SCGs are available or are being developed for most of the drugs listed as AMBER. |
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Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria.
These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary.
In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary.
If the drug requires urgent initiation, it is expected that the specialist provides the first prescription from the inpatient/outpatient setting, of sufficient supply for a patient’s immediate needs. The quantity provided should cover at least up to the point where the discharge/clinic letter has reached the GP, plus reasonable time for the practice to manage the document and issue further supplies. A GREEN+ drug can only be recommended to primary care for initiation if it does not need to be initiated urgently, taking into account clinical need. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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Self-care – available OTC, can be purchased as part of self-care for self-limiting conditions as per NHSE policy guidance |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care. |
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