11.0 Eye

11.3.1 Antibacterials

First line: broad spectrum of activity, suitable for superficial eye infections. 

GREEN      Chloramphenicol

                   eye drops 0.5%                                                                                   

                     ophthalmic ointment 1%                                                                      

                   unit dose eye drops 0.5%    

Second line: it is recommended to do a culture and sensitivity before prescribing these preparations. Fusidic acid is useful for staphylococcal infections and gentamicin for pseudomonal infections.

GREEN      Fusidic acid gel eye drops 1%                                                           

GREEN      Gentamicin

                   eye/ear drops 0.3%                                                                                                                              

RED           Ofloxacin eye drops 0.3% (specialist use only)                                

RED           Cefuroxime 5% eye drops (specialist use only)                        

RED           Gentamicin eye drops 1.5% (specialist use only)                     

RED           Clotrimazole 1% drops (specialist use only)                             

RED           Levofloxacin  (2nd line, specialist use only)      

                  0.5% eye drops

                 unit dose eye drops 0.5%

11.3.3 Antivirals

For use in Herpes simplex infections of the eye.

GREEN      Aciclovir eye ointment 3%                                                       

GREEN      Ganciclovir eye ointment                                                         

11.4.1 Corticosteroids

Topical corticosteroids should normally only be used with expert supervision. 

GREEN      Betamethasone eye/ear/nose drops 0.1%                                                  

GREEN      Betnesol-N® eye/ear/nose drops                                                                 

GREEN      Dexamethasone eye drops 0.1 (Maxidex®)                                             

GREEN      Fluorometholone eye drops 0.1%                                                             

GREEN      Maxitrol® eye drops, eye ointment                                                               

GREEN      Prednisolone eye/ear drops 0.5%                                                             

GREEN      Predsol-N® eye/ear drops                                                                            

AMBER     Prednisolone eye drops 1% (forte)(specialist use only)                           

For the treatment of post operative inflammation following ocular surgery in patients who are at risk of corticosteroid induced raised intra-ocular pressure.

AMBER     Loteprednol drops 0.5% (specialist use only)                                         

RED           Dexamethasone intravitreal implant 700mcg (specialist use only)                                                                                                     (For further information, see NICE TA229) 

For the treatment of sight problems caused by diabetic macular oedema if:

• there is an artificial lens in the eye to be treated, and
  
• diabetic macular oedema has not improved with non-corticosteroid treatment, or such treatment is not suitable for them.                                                                                                                                                                     See NICE TA349

RED           Dexamethasone intravitreal implant 700mcg (specialist use only)

NICE TAG301 (rapid review of TAG271) for treating chronic diabetic macular oedema after an inadequate response to prior therapy.

RED           Fluocinolone acetonide intravitreal implant (Iluvien®)

11.4.2 Other anti-inflammatory preparations

Used to treat inflammation and allergic conjunctivitis.

GREEN      Otrivine-Antistin® eye drops                                                                             

GREEN      Sodium cromoglicate eye drops 2% (1st line option)                                     

AMBER      Olopatadine eye drops 1mg/ml                                                                                                                                                              (Consultant initiation only. 2nd line option, when first line of management fails or not adequate).

Antimuscarinics dilate the pupil and paralyse the ciliary muscle.

GREEN    Atropine unit dose eye drops 1%                                               

RED           Cyclopentolate

                   eye drops 0.5%, 1%                                                                           

                   unit dose eye drops 0.5%, 1%                                                    

RED           Phenylephrine unit dose eye drops 2.5%                                  

GREEN      Tropicamide 0.5%, 1% eye drops (with preservative)                       

                   Tropicamide unit dose eye drops 0.5%, 1%                              

In glaucoma there is a high intraocular pressure. 

Beta blockers probably reduce the rate of production of aqueous humour. 

AMBER     Timolol eye drops 0.25%,  

AMBER     Timolol 1mg/g eye gel (Tiopex®) 0.4g Unit Dose PF                                                                                                                               (for use in selective patients only)      

Prostaglandin analogue - increases uveoscleral outflow.  Latanoprost is first line therapy

AMBER     Latanoprost eye drops                                                                            

AMBER     Latanoprost unit dose preservative free eye drops                                                                                                                           (2nd line option for those who are intolerant to preservatives)

AMBER     Bimatoprost 0.01% eye drops                                                                                                                                                                  (2nd line use when latanoprost not effective)      

Sympathomimetics probably reduce the rate of production of aqueous humour and increase its outflow.

AMBER     Brimonidine eye drops 0.2%                                                                        

Carbonic anhydrase inhibitors and systemic drugs reduce aqueous humour production.

AMBER     Acetazolamide tablets 250mg                                                                      

                  Acetazolamide capsules m/r 250mg                                                            

RED          Acetazolamide injection 500mg

AMBER     Dorzolamide eye drops 2%                                                                           

AMBER     Brinzolamide eye drops 10mg/ml (Azopt®)                                                                                                                                          (Restricted use only following an unsuccessful trial of dorzolamide)

Combination products

AMBER     Dorzolamide 2% & timolol 0.5% eye drops  (Cosopt®) *prescibe as generic*                           

AMBER     Ganfort® eye drops (bimatoprost 0.03% & timolol 0.05% eye drops)   

AMBER      Azarga® eye drops brinzolamide 10mg/ml + timolol 5mg/ml       

AMBER     Ganfort® unit dose eye drops P/F - as an option when intolerant to preservative

AMBER     Simbrinza® eye drops (brinzolomide & brimonidine) - as 3rd line option, consultant  initiation only,                                       in patients unsuitable for surgery

Pilocarpine and adrenaline are now outdated treatments. Use pilocarpine only for existing patients who are stable and have no problems with its use

Miotics - open up the inefficient drainage channels.

AMBER     Pilocarpine

                   eye drops 1%, 2%, 3%, 4%

                   unit dose eye drops 4%

Radiation-induced xerostomia, Sjogren’s syndrome 

AMBER     Pilocarpine tablets 5mg (Salagen®) 

Used before surgery on the eye. Not to be used for the management of ocular symptoms. 

RED           Tetracaine unit dose eye drops 0.5%, 1%

RED           Oxybuprocaine (benoxinate) unit dose eye drops 0.4%

RED           Proxymetacaine unit dose eye drops 0.5%, 1%

RED            Lidocaine & fluorescein unit dose eye drops 4%+0.25%

11.8.1 Tear deficiency, ocular lubricants and astringents

In order of increasing cost:

GREEN      Sno-Tears® eye drops                                                                                          

GREEN     Hypromellose 0.3% eye drops                                                          

GREEN     Clinitas Gel® eye drops                                                                      

                  Clinitas® UDV 0.4%                                                                          

GREEN     VitA-POS® eye ointment                                                                     

GREEN      Sodium chloride eye drops 0.9%                                                     

GREEN     llube® eye drops                                                                                  

GREEN     Sodium chloride unit dose eye drops 0.9%                                   

Ciclosporin for treatment of dry eye disease that has not improved despite treatment with artificial tears is recommended as an option by NICE. NICE TA369 

AMBER     Ciclosporin (Ikervis®) unit dose eye drops

Hylo preparations are preservative free and supplied in a unique delivery device that assures 6 month sterility. They are cost effective to use when viability beyond 28 days is required. If being used more frequently the prescriber is reminded to use as second line after other products have been tried and not tolerated. 

GREEN     Hylo-Tear® eye drops                                                                     

                 Hylo-Forte® eye drops                                                                      

                    Sodium Chloride 5% eye drops                                                       

11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment 

Ocular diagnostic preparations 

AMBER     Apraclonidine eye drops 0.5% 

RED           Fluorescein unit dose eye drops 1%, 2%

RED          Proxymetacaine & fluorescein unit dose eye drops 0.5%

Ocular peri-operative drugs

RED           Balanced Salt Solution®

AMBER        Diclofenac unit dose eye drops 0.1%

AMBER        Ketorolac eye drops 0.5%

RED          Miochol-E® solution for intra-ocular irrigation

RED          Sodium hyaluronate injection 10mg/ml, 14mg/mL, 23mg/mL

Approved for specific use in ophthalmolgy for volume enhancement of post-enucleation socket syndrome:

RED          Hyaluronic acid injection (Restylane Sub-Q,® Juvederm®) 

Approved for use in opthalmology for those at higher risk of developing post-surgical cystoid macular oedema:

RED         Bromfenac eye drops (Yellox®) 

Subfoveal choroidal neovas cullarisation                                                                                                                                           For use as per NICE guidance only. 

RED         Verteporfin injection 15mg vial

Aflibercept                                                                                                                                                                                                Approved for use in line with NICE guidance

TAG294    Wet age-related macular degeneration

TAG305   Visual Impairment caused by macular oedema secondary to central retinal vein occlusion

TAG 346   Treatment for some people with sight problems caused by diabetic macular oedema 

RED           Aflibercept solution for intravitreal injection 40mg/mL

Vitreomacular traction                                                                                                                                                                           Orciplasmin for use in accordance with NICE guidance as an option in NICE TA297 

RED          Orciplasmin concentrate for solution for intravitreal injection 2.5mg/mL                                                                                      (Each vial contains 0.5 mg of ocriplasmin in 0.2 ml solution)

Ranibizumab                                                                                                                                                                                             Approved for use in accordance with NICE guidance:

TA283      Visual Impairment caused by Macular oedema secondary to retinal vein occlusion

TA274      Diabetic macular oedema (DMO)

TA155      Wet age-related macular degeneration (AMD)

TAG298    Choroidal neovascularisation associated with pathological myopia 

RED           Ranibizumab solution for intravitreal injection 10mg/mL vial