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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)

Blepharitis: off licence use of doxycycline 50mg tablets is an option to consider in NICE CKS for the treatment of 
blepharitis only under the direction of an optometrist.
AMBER      Doxycycline tablets 50mg

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) 

RED Fluocinolone acetonide intravitreal implant (Iluvien®)

NICE TA301 for treating chronic diabetic macular oedema after an inadequate response to prior therapy.                                                [Rapid review of TA271]                                                                                       NHS England Commissioned               

NICE TA590  Fluocinolone acetonide intravitreal implant is recommended as an option for preventing relapse in recurrent non-infectious uveitis affecting posterior segment of the eye. It is recommended only if the company provides it according to the commercial arrangement.                                                NHS England Commissioned

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

Lutein and Oral Antioxidants Vitamin Supplements for Eye Conditions - prescribing guidance

Dry Eye Patient Information Leaflet
GREEN* Self-care policy applies - advise patient to purchase where appropriate 

GREEN*      Sno-Tears® 1.4% eye drops [Polyvinyl alcohol] 
GREEN*      Hypromellose 0.3% eye drops 
GREEN*      Clinitas Gel® eye drops [Carbomer] 
GREEN*      HYLO-NIGHT® eye ointment (formerlyVitA-POS® eye ointment)   
GREEN*       Lacri-Lube eye ointment 
AMBER       llube® eye drops    
AMBER       Hylo-Forte® eye drops  (Consultant initiation only, reserved for dexterity issues) 
                     [Self-care should be considered for mild/moderate dry eye not associated with a co-morbidity]
AMBER       Systane® BALANCE lubricant eye drops
                    (Specialist initiation only for Dry eye  symptoms associated with Meibomian gland dysfunction)   
AMBER       Ciclosporin (Ikervis®) unit dose eye drops - PRESCRIBE BY BRAND 
                    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      Sodium Chloride 5% eye drops 
AMBER      Ciclosporin 0.1% eye drops 0.3ml unit dose (Verkazia®)  -- Specialist initiation
RED            Cross Linked Hyaluronic Acid & Co Enzyme Q10 (VisuXL®) Specialist use only  
RED            Carbomer single use eye gel  (Viscotears® eye gel 0.6ml unit dose) NICU use only

Severe Dry Eye Only
GREEN*    Evolve HA® eye drops (preservative free)  
                   [Self-care should be considered for mild/moderate dry eye not associated with a co-morbidity]
GREEN*    Xailin HA® (sodium hyaluronate 0.2% Preservative Free) 
                   [Self-care should be considered for mild/moderate dry eye not associated with a co-morbidity]
GREEN*    Blink® Intensive Tears** 10ml and 0.4ml unit dose drops [Sodium hyaluronate 0.2%) 
                 **[1st line choice hyaluronate in Primary Care]
Access information about the MINOR EYE CONDITIONS SERVICE

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 

Approved for use in line with NICE guidance
NICE TA294     Wet age-related macular degeneration  
NICE TA305     Visual Impairment caused by macular oedema secondary to central retinal vein occlusion 
NICE TA346     Treatment for some people with sight problems caused by diabetic macular oedema   
NICE 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  [Eylea 2mg/50microlitres solution for intravitreal injection]           (NHS England Commissioned)  
Vitreomacular traction  
Ocriplasmin for use in accordance with NICE guidance as an option in NICE TA297  
RED          Ocriplasmin concentrate for solution for intravitreal injection 2.5mg/mL 
                  (Each vial contains 0.5 mg of ocriplasmin in 0.2 ml solution)
Approved for use in accordance with NICE guidance: 
NICE TA283      Visual Impairment caused by Macular oedema secondary to retinal vein occlusion 
NICE TA274      Diabetic macular oedema (DMO) 
NICE TA155      Wet age-related macular degeneration (AMD) 
NICE TA298     Choroidal neovascularisation associated with pathological myopia  
RED           Ranibizumab solution for intravitreal injection 10mg/mL vial 
Wet age-related macular degeneration

NICE TA672    Recommended as an option for treating wet age-related macular degeneration in adults 
                       [as per NICE guidance]
RED           Brolucizumab solution for injection pre-filled syringes 19.8mg/0.165ml
                                                                                                                                 CCG Commissioned Blueteq form required







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