| Formulary Chapter 11: Eye - Full Chapter
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| Notes: |
This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.
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| Details... |
| 11.01 |
Administration of drugs to the eye |
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| 11.02 |
Control of microbial contamination |
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| 11.03 |
Anti-infective eye preparations |
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| 11.03.01 |
Antibacterials |
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Chloramphenicol
|
First Choice
|
Eye drops 0.5%
Eye drops 0.5% - preservative free (only for use in patients with a documented allergy to preservatives)
East Lancashire only - use as by ophthalmology when more than 5 days treatment required post op
Eye ointment 1%
Chloramphenicol eye drops 0.5% can be sold by a community pharmacy to the public (for people over 2 years of age) for the treatment of acute bacterial conjunctivitis.
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 LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 MHRA: Chloramphenicol eye drops containing borax or boric acid buffers: use in children younger than 2 years
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Gentamicin
|
Second Choice
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Eye/ear drops 0.3%
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Chloramphenicol (Minims®)
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Formulary
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Minims® 0.5%
Follow local ophthalmology policies
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MHRA: Chloramphenicol eye drops containing borax or boric acid buffers: use in children younger than 2 years
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Ciprofloxacin
|
Formulary
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Eye drops 0.3%
*under review*
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Fusidic Acid
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Formulary
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Eye drops 1% in gel basis (liquefies on contact with eye)
Second line - Restricted use
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Levofloxacin
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Formulary
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eye drops 0.5%
preservative-free eye drops 0.5% - reserved for patients with a documented allergy to preservatives or for intensive use
*under review*
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Propamidine Isetionate (Brolene®)
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Formulary
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Eye drops 0.1%
Specialist use only for treatment of acanthamoeba keratitis
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Cefuroxime
|
 Unlicensed
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Eye drops 5%
Unlicensed - consultant ophthalmologist only
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Chlorhexidine 0.02% eye drops
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Unlicensed
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Eye drops 0.02%
Unlicensed - Consultant ophthalmologist only. Morecambe bay only
* under review*
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MHRA: Medical Device Alert
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Gentamicin Forte
|
Unlicensed
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Preservative free eye drops 1.5%
Unlicensed - consultant ophthalmologist only
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Polihexanide
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 Restricted
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Eye drops 0.02%
Specialist use only for treatment of fusarium keratitis
Also known as polyhexamethylene biguanide (PHMB)
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| 11.03.02 |
Antifungals |
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Clotrimazole drops
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Formulary
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1% drops
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Amphotericin B
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Restricted
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Eye drops 0.15% preservative free
Unlicensed - Specialist use only
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| 11.03.03 |
Antivirals |
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Ganciclovir 0.15% ophthalmic gel (Virgan®)
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Formulary
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Eye gel 5g (1.5mg/g)
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Ofloxacin eye drops
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Formulary
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0.3% drops
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| 11.04 |
Corticosteroids and other anti-inflammatory preparations |
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| 11.04.01 |
Corticosteroids |
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Topical corticosteroids should normally only be used under expert supervision |
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Betamethasone eye drops
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Formulary
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Eye/ear/nose drops 0.1%
in East Lancashire
*under review*
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Dexamethasone eye drops
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Formulary
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Eye drops preservative free 0.1%
in East Lancashire
*under review*
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Dexamethasone eye drops (Maxidex®)
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Formulary
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Eye drops 0.1%
in East Lancashire
*under review*
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Dexamethasone eye drops single use
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Formulary
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Single dose - preservative free drops 0.1% - for use in theatre or clinic before a procedure if a single dose is needed.
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Dexamethasone intravitreal implant (Ozurdex®)
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Formulary
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Intravitreal implant 700micrograms in disposable applicator
REQUIRES BLUETEQ APPROVAL
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NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis
NICE TA824: Dexamethasone intravitreal implant for treating diabetic macular oedema
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Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
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Formulary
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Eye drops dexamethasone 0.1%, neomycin 3500u/g, polymixin B sulfate 6000units/g
Eye ointment dexamethasone 0.1%, neomycin 3500u/g, polymixin B sulfate 6000units/g
 in East Lancashire
*under review*
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Dexamethasone with Tobramycin (Tobradex®)
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Formulary
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Eye drops - dexamethasone 1mg/ml, tobramycin 3mg/ml
Restricted to post cataract surgery patients who are intolerant to Maxitrol
Morecambe bay only
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Fluocinolone intravitreal implant (Iluvien®)
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Formulary
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Intravitreal implant 190micrograms in a disposable applicator
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NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
NICE TA953: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema
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Fluorometholone (FML®)
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Formulary
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Eye drops fluoromethalone 0.1%, polyvinyl alcohol 1.4%
in East Lancashire
*under review*
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Hydrocortisone sodium phosphate 3.35 mg/ml eye drops (Softacort)
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Formulary
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Eye drop - 2 week course only
1 ml eye drops, solution contains 3.35 mg of hydrocortisone sodium phosphate.
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Intravitreal triamcinolone acetonide (Intracinol®)
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Formulary
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Loteprednol (Lotemax®)
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Formulary
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Eye drops 0.5% (5mg/ml)
Restricted to second line use or if clinical condition warrants.
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Prednisolone (Pred Forte®)
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Formulary
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Eye drops 1%
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Prednisolone eye drops
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Formulary
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Eye drops 0.5%
Unit dose eye drops preservative free 0.5% - only for patients with a documented allergy to preservatives
in East Lancashire
*under review*
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| 11.04.02 |
Other anti-inflammatory preparations |
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Sodium Cromoglicate
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First Choice
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Eye drops 2%
Can be sold to the public (maximum pack size 10mL) for the treatment of acute seasonal and perennial allergic conjunctivitis
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
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Olopatadine (Opatanol®)
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Second Choice
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Eye drops 1mg/mL (0.1%)
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Ketotifen (Ketofall®)
(preservative free)
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Formulary
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Eye drops (preservative free) 250micrograms/mL
Should only be prescribed when:
- a patient has tried at least 2 alternative eye preparations for seasonal allergic conjunctivitis
- and/or the patient is sensitive to preservatives
*under review*
 in East Lancashire
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Sodium cromoglicate preservative free
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Formulary
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Preservative free eyedrops 2% - Only for patients with a document allergy to preservatives.
*under review*
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| 11.05 |
Mydriatics and cycloplegics |
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Mydrane
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Formulary
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Solution for injection - lidocaine hydrochloride 10mg/ml, phenylephrine hydrochloride 3.1mg/ml, tropicamide 200microgram/ml
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Mydriasert
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Formulary
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Ophthalmic inserts - phenylephrine hydrochloride 5.4mg, Tropicamide 28mg
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| 11.05 |
Antimuscarinics |
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Atropine
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Formulary
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Eye drops 1%
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Atropine Sulphate single use (Minims® Atropine Sulphate)
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Formulary
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Minims® 1%
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Cyclopentolate
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Formulary
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Eye drops 0.5%, 1%
in East Lancashire
*under review*
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Cyclopentolate Hydrochloride single use (Minims® Cyclopentolate Hydrochloride)
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Formulary
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Minims® 0.5%, 1%
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Tropicamide single use (Minims® Tropicamide)
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Formulary
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Minims® 0.5%, 1%
in Morecambe Bay
*under review*
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| 11.05 |
Sympathomimetics |
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Phenylephrine Hydrochloride (Minims® Phenylephrine Hydrochloride )
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Formulary
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Minims® 2.5%, 10%
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| 11.06 |
Treatment of glaucoma |
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Treatment for glaucoma should be initiated by a consultant or specialist in ophthalmology, repeat prescriptions however should be provided in primary care. |
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| 11.06 |
Beta-blockers |
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CSM advice: Beta-blockers, even those with cardioselectivity should be avoided in patients with asthma or a history of COPD unless no other alternative treatment is available - see BNF |
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Timolol
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First Choice
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eye drops 0.25%, 0.5%
Preservative free eye drops 0.25%, 0.5%
Long acting eye drops 0.25%, 0.5% (Timoptol LA®)
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Betaxolol (Betoptic®)
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Second Choice
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Eye drops 0.25%, 0.5%
*under review*
Not listed on East Lancashire formulary
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Levobunolol (Betagan®)
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Formulary
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Unit dose - preservative free eye drops levobunolol 0.5%/polyvinyl alcohol 1.4%
*under review*
Not listed on East Lancashire formulary
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| 11.06 |
Prostaglandin analogues |
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Latanoprost
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First Choice
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Eye drops 50micrograms/mL
Unit dose eye drops (preservative free)50micrograms/mL
Multidose eye drops (preservative free) 50micrograms/mL (Lotacryn)
The preservative free preparations are restricted to use in patients who have a proven sensitivity to benzalkonium chloride.
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Bimatoprost
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Formulary
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Eye drops 100micrograms/mL (0.01%)
Eye drops 300micrograms/mL (0.03%)
Eye drops - Preservative free 300micrograms/mL (0.03%) - only for patients with a documented allergy to preservatives
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Bimatoprost with Timolol
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Formulary
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Eye drops bimatoprost 300micrograms/mL (0.03%)/timolol 5mg/mL (0.5%)
Eye drops - preservative free bimatoprost 300micrograms/mL (0.03%)/timolol 5mg/mL (0.5%) - only for patients with a documented allergy to preservatives
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Latanoprost - Netarsudil eyedrops (Roclanda®)
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Formulary
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Only to be used if a prostaglandin analogue alone and then a subsequent fixed -dose combination has not reduced IOP sufficiently or a fixed dose combination treatment containing beta-blockers is unsuitable.
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NICE TA1009: Latanoprost–netarsudil for previously treated primary open-angle glaucoma or ocular hypertension
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Latanoprost 0.005% with Timolol 0.5%
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Formulary
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Eye drops 50micrograms/mL (0.005%)/ timolol 0.5%
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Latanoprost and timolol (Fixapost®)
(Unit dose eye drops)
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Formulary
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Unit dose eye drops 0.2mL Latanoprost 50micrograms/ml, Timolol 5mg/ml
This has been approved only for patients with documented preservative allergy.
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Travoprost
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Formulary
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Eye drops 40micrograms/mL (0.004%)
*under review*
Not on East Lancashire formulary
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Travoprost with Timolol
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Formulary
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Eye drops 40micrograms/mL (0.004%)/ timolol 0.5%
*under review*
Not on East Lancashire formulary
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| 11.06 |
Sympathomimetics |
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Apraclonidine (Iopidine®)
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Formulary
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Eye drops 0.5%
*under review*
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Brimonidine Tartrate
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Formulary
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Eye drops 0.2%
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Brimonidine Tartrate 0.2% with Timolol 0.5%
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Formulary
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Eye drops brimonidine 0.2%/timolol 0.5%
*under review*
Not on East Lancashire formulary
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| 11.06 |
Carbonic anhydrase inhibitors and systemic drugs |
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Dorzolomide
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First Choice
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Eye drops 2%
Eye drops - preservative free 2% - only for patients with a documented allergy to preservatives
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Brinzolamide
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Second Choice
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Eye drops 10mg/mL (1%)
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Acetazolamide
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Formulary
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Injection 500mg
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Acetazolamide
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Formulary
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Tablets 250mg
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Brinzolamide 1% with Timolol 0.5% (Azarga®)
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Formulary
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Ophthalmic suspension brinzolamide 10mg/timolol 5mg/mL
Second line carbonic anhydrase inhibitor with timolol
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Dorzolamide 2% with Timolol 0.5%
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Formulary
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Eye drops dorzolamide 2%/timolol 0.5%
Eye drops - preservative free dorzolamide 2%/timolol 0.5% - only for patients with a documented allergy to preservatives.
First line carbonic anhydrase inhibitor with timolol
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Brinzolamide 10mg/ml & brimonidine 2mg/ml (Simbrinza®)
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Formulary
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Eye drops brinzolamide 10mg/mL/brimonidine 2mg/mL
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| 11.06 |
Miotics |
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Pilocarpine
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Formulary
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Eye drops 1% 2%
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Pilocarpine
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Formulary
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Minims® 2%
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| 11.07 |
Local anaesthetics |
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Lidocaine Hydrochloride 4% with Fluorescein 0.25% (Minims®)
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Formulary
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Minims® lidocaine 4%/fluorescein 0.25%
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Oxybuprocaine Hydrochloride (Minims® )
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Formulary
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Minims® 0.4%
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Proxymetacaine Hydrochloride (Minims®)
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Formulary
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Minims® 0.5%
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Tetracaine Hydrochloride (Minims® Amethocaine Hydrochloride)
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Formulary
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Minims® 1%
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| 11.08 |
Miscellaneous ophthalmic preparations |
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Potassium ascorbate
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Unlicensed
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Eye drops 10%
*under review*
Not on East Lancashire formulary
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| 11.08.01 |
Tear deficiency, ocular lubricants, and astringents |
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Acetylcysteine 5% with Hypromellose 0.35% (Ilube®)
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Formulary
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Eye drops
For treatment of filamentary keratitis only
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Carbomer 980 eye drops
(polyacrylic acid)
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Formulary
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Liquid gel eye drops 0.2%
Liquid gel unit dose eye drops 0.2%
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Carmellose
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Formulary
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Preservative free eye drops 0.5%, 1%
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Hydramed Night®
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Formulary
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Lubricating eye ointment 5g
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Hylo-night ®
(formerly known as VitA-Pos®)
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Formulary
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Eye ointment preservative free
2nd line to Hydramed Night
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Hypromellose
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Formulary
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Eye drops 0.3%
Preservative free eye drops 0.3%
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Polyvinyl Alcohol (Liquifilm Tears®)
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Formulary
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Eye drops 1.4%
Unit dose eye drops 1.4%
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
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Sodium Chloride (Minims® Saline)
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Formulary
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0.9% Minims®
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Sodium Hyaluronate
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Formulary
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Eye drops 0.2%
Eye drops - preservative free 0.1% & 0.2%
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Sodium Chloride
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Unlicensed
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Preservative free eye drops 5% (unlicensed)
*under review*
in East Lancashire
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| 11.08.02 |
Ocular diagnostic and peri-operative preparations and photodynamic treatment |
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| 11.08.02 |
Ocular diagnostic preparations |
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Fluorescein Sodium
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Formulary
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Minims® 1%, 2%
Injection 10% for WAMD clinic use only
Injection 20%
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Indocyanine green
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Formulary
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Injection 25mg (unlicensed)
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Trypan Blue (Vision Blue®)
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Formulary
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Injection
For use in cataract surgery
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| 11.08.02 |
Ocular peri-operative drugs |
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Acetylcholine Chloride (Miochol-E®)
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Formulary
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Intra-occular irrigation 1%
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Apraclonidine (Iopidine®)
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Formulary
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Unit dose eye drops 1% - perioperative use only
*under review*
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Balanced Salt Solution
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Formulary
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Sterile irrigation solution 15mL, 500mL
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Bromfenac (Yellox®)
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Formulary
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Eye drops 0.09%
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Diclofenac (Voltarol® Ophtha)
|
Formulary
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Eye drops 0.1%
Unit dose eye drops 0.1%
*under review*
 in East Lancashire
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Ketorolac
|
Formulary
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Eye drops 0.5%
*under review*
in East Lancashire
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Povidone iodine
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Formulary
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Unit dose eye drops 5%
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Sodium hyaluronate
(Obtained from central stores)
|
Formulary
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Injection 1%
Injection prefilled syringe 15mg in 1mL
Injection prefilled syringe 14mg in 1mL (Haelonid GV®)
Irrigation 40mg/50mL
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Disodium edetate
(EDTA)
|
Unlicensed
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Preservative free solution 0.37%
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| 11.08.02 |
Subfoveal choroidal neovascularisation |
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Aflibercept (Eylea®)
|
Formulary
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Solution for intravitreal injection pre-filled syringe 40mg/mL
|
MHRA: Aflibercept (Zaltrap▼): minimising the risk of osteonecrosis of the jaw
NICE TA: Aflibercept for treating diabetic macular oedema
NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
NICE TA486: Aflibercept for treating choroidal neovascularisation
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Brolucizumab (Beovu®
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Formulary
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19.8mg/0.165ml solution for injection pre-filled syringes
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MHRA: Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
NICE TA672: Brolucizumab for treating wet age-related macular degeneration
NICE TA820: Brolucizumab for treating diabetic macular oedema
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Faricimab (Vabysmo ®)
|
Formulary
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Solution for injection 120 mg/mL
|
NICE TA1004: Faricimab for treating visual impairment caused by macular oedema after retinal vein occlusion
NICE TA799: Faricimab for treating diabetic macular oedema
NICE TA800: Faricimab for treating wet age-related macular degeneration
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Ranibizumab
|
Formulary
|
Solution for intravitreal injection 10mg/mL
 For NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)
|
NICE TA274: Ranibizumab for treating diabetic macular oedema
NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)
|
Verteporfin injection
|
Formulary
|
15mg vial
|
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| 11.08.02 |
Vitreomacular traction |
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| 11.08.03 |
Reduction of elevated intra-ocular pressure |
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| 11.09 |
Contact lenses |
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See BNF |
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| 11.10 |
Additional treatments used in the management of ophthalmic conditions not listed in BNF chapter 11 |
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Adalimumab
|
Formulary
|
Solution for injection
|
NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis
|
| 11.11 |
Miscellaneous |
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| 11.11 |
Antifungals |
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| 11.11 |
Cytotoxics / wound healing modulators |
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| 11.11 |
Fibrinolytic drugs |
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| 11.11 |
Glues - ocular |
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| 11.11 |
Immunosuppressants |
|
|
Ciclosporin 0.1% eye drops (Ikervis®)
|
Formulary
|
Unit dose eye drops 0.3mL
For adults
|
NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
|
Ciclosporin 0.1% eye drops (Verkazia®)
|
Formulary
|
Unit dose eye drops 0.1% 0.3mL
For children and adolescents
|
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| 11.11 |
Treatment of burns |
|
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| 11.11 |
Visco-elastics |
|
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| 11.11 |
Other |
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Holoclar
|
Formulary
|
79,000 - 316,000 cells/cm2 living tissue equivalent
|
NICE TA467: Holoclar for treating limbal stem cell deficiency after eye burns
|
Voretigene neparvovex (Luxturna®)
|
Formulary
|
Tertiary Centre only
|
NICE: Voretigene neparvovec for treating inherited retinal dystrophies caused by RPE65 gene mutations
|
| .... |
Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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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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Traffic Light Status Information
| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
|
Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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|
Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
|
Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
|
Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
|
Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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