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11.0 Eye

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% 
 
RED           Chloramphenicol eye drops 0.5% PF (Eykappo®) 
                   For use by opthalmology ONLY  
                   (where treatment is required for more than 5 days)

 
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% 

 Acanthamoeba keratitis infections and Fusarium keratitis infections

RED          Propamidine isetionate 0.1% eye drops (specialist use only)

RED          Polymeric polyhexamethylene biguanide 0.02% eye drops (specialist use only)


11.3.3 Antivirals

For use in Herpes simplex infections of the eye.
GREEN      Ganciclovir eye ointment      
                   [alternative to Aciclovir eye ointment [discontinuation due June 2019. 

                   Note: not licensed for use in children under 18 years of age]

 

                                                  

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 guidance for treating non-infectious uveitis (as an option in) TA460;                         NHS England Commissioned
 
RED           Adalimumab solution for injection
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).

                                                                                                                                                        

11.5 Mydriatics and cycloplegics

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%    

     

RED           Tropicamide/phenylephrine  opthalmic inserts (Mydriasert®)
                   (Specialist use only -  pre-operative mydraisis or diagnostic purposes when 
                                     monotherapy is known to be insufficient
)

                      

11.6 Treatment of glaucoma

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
AMBER     Xalacom® eye drops (latanoprost 50mcg/mL/timolol 5mg/mL)
 
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®) 
                  when 1st line topical agents have not been effective

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     Viscotears gel 0.2% 

GREEN      Lacri-Lube                                        

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 - PRESCRIBE BY BRAND

RED         Cross Linked Hyaluronic Acid & Co Enzyme Q10 (VisuXL®) Specialist use only 

GREEN    Evolve HA® eye drops (preservative free)         

AMBER   Systane® BALANCE lubricant eye drops (Specialist initiation only for Dry eye symptoms associated with                                    Meibomian gland dysfunction)

GREEN     Hylo-Tear® eye drops      

GREEN    Blink® Intensive Tears 10ml and 0.4ml unit dose drops                                                         

AMBER    Hylo-Forte® eye drops   (Consultant initiation only, reserved for dexterity issues)                

GREEN      Sodium Chloride 5% eye drops   

AMBER    Ciclosporin (Ikervis®) unit dose eye drops  PRESCRIBE BY BRAND

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 
TA486       An option for treating visual impairment because of myopic choroidal  neovascularisation in adults,
                  only if the company provides aflibercept  with the discount agreed in the patient access scheme
 
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)
TA298      Choroidal neovascularisation associated with pathological myopia 
RED           Ranibizumab solution for intravitreal injection 10mg/mL vial