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Approved: 1 Jan 2013. Last amended: 19 Mar 2024.

11.1 Administration of drugs to the eye

Refer to BNF for guidance regarding administration of eye drops, ointments and lotions.

11.2 Control of microbial contamination

Refer to BNF and local guidelines for information regarding the control of microbial contamination.

11.3 Anti-infective eye preparations

11.3.1 Antibacterials

Recommended

  • Non-specialist or Specialist
    Chloramphenicol 0.5%

    Eye drops

  • Non-specialist or Specialist
    Chloramphenicol 1%

    Eye ointment

  • Alternative

  • Non-specialist or Specialist
    Ciprofloxacin 0.3%

    Eye drops

  • Non-specialist or Specialist
    Fusidic acid 1%

    Eye drops in gel basis

  • Non-specialist or Specialist
    Gentamicin 0.3%

    Eye drops

  • Non-specialist or Specialist
    Ofloxacin 0.3%

    Eye drops

  • Specific Indication

  • Hospital or Specialist only
    Gentamicin 1.5%

    Eye drops – hospital only

  • Non-specialist or Specialist
    Polymixin B sulphate

    Eye ointment (Polyfax®) – facial lacerations N.B. This is not the topical ointment

  • 11.3.2 Antifungals

    Not recommended

    11.3.3 Antivirals

    Recommended

  • Non-specialist or Specialist
    Aciclovir 3%

    Eye ointment

  • 11.4 Corticosteroids and other anti-inflammatory preparations

    11.4.1 Corticosteroids

    Recommended

  • Non-specialist or Specialist
    Betamethasone 0.1%

    Eye drops or ointment

  • Non-specialist or Specialist
    Prednisolone 0.5%

    Eye drops (Predsol®)

  • Non-specialist or Specialist
    Prednisolone 1%

    Eye drops (Pred Forte®)

  • Non-specialist or Specialist
    Dexamethasone 0.1%

    Eye drops (Maxidex®)

  • Non-specialist or Specialist
    Dexamethasone 0.1% & tobramycin 0.3%

    Eye drops (Tobradex®)

  • Specific Indication

  • Non-specialist or Specialist
    Prednisolone 0.5%

    Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops

  • Non-specialist or Specialist
    Dexamethasone 0.1%

    Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops

  • Hospital or Specialist only
    Loteprednol 0.5%

    Post-operative inflammation in patients with elevated eye pressures or known steroid-induced elevated eye pressure response to recommended topical steroids

  • 11.4.2 Intravitreal corticosteroids

    Specific Indication

  • Hospital or Specialist only
    Dexamethasone

    Intravitreal implant

  • Hospital or Specialist only
    Fluocinolone acetonide

    Intravitreal implant

  • 11.4.3 Other anti-inflammatory preparations

    Recommended

  • Non-specialist or Specialist
    Sodium cromoglicate 2%

    Eye drops

    Note: As per NHS England advice, patients should be directed to purchase sodium cromoglicate over-the-counter for allergic conjunctivitis

  • Specific Indication

  • Non-specialist or Specialist
    Olopatadine

    Eye drops

    Second-line when sodium cromoglicate is ineffective

  • Non-specialist or Specialist
    Ketotifen

    Ketofall® Eye drops

    Third-line when sodium cromoglicate is ineffective and patient has a documented preservative allergy

  • 11.5 Mydriatics and cycloplegics

    11.5.1 Antimuscarinics

    To examine the fundus of the eye tropicamide 0.5% eye drops should be used.

    Recommended

  • Non-specialist or Specialist
    Cyclopentolate 0.5% or 1%

    eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Cyclopentolate 0.5% or 1%

    Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops

  • Non-specialist or Specialist
    Tropicamide 0.5% or 1%

    Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops

  • 11.5.2 Sympathomimetics

    Recommended

  • Non-specialist or Specialist
    Phenylephrine 2.5%

    Single-use eye drops (Minims®)

  • Specific Indication

  • Hospital or Specialist only
    Mydriasert®

    Tropicamide and phenylephrine ophthalmic insert.

    Restricted to use prior to cataract surgery.

  • Hospital or Specialist only
    Mydrane®

    Tropicamide, phenylephrine and lidocaine solution for intracameral injection.

    Restricted for use in patients where mydriasis with topical treatment is inadequate prior to cataract surgery.

  • 11.6 Treatment of glaucoma

    11.6.1 Beta-blockers

    Recommended

  • Non-specialist or Specialist
    Timolol 0.25% or 0.5%

    Eye drops

  • Alternative

  • Non-specialist or Specialist
    Betaxolol 0.5%

    Eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Timolol 0.25% or 0.5%

    Single-use eye drops – patients who are allergic to preservative containing eye drops

  • 11.6.2 Prostaglandin analogues and prostamides

    Recommended

  • Non-specialist or Specialist
    Latanoprost 50mcg/ml

    Eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Travoprost 40mcg/ml

    Eye drops – patients who are unable to tolerate latanoprost

  • Non-specialist or Specialist
    Bimatoprost 0.1mg/ml

    Eye drops – patients who are unable to tolerate latanoprost

  • 11.6.2.1 Preservative Free

    Note: Preservative free eye drops may only be prescribed for patients who have a demonstrated allergy or intolerance to the preservative benzalkonium chloride

    Recommended

  • Non-specialist or Specialist
    Latanoprost 50mcg/ml

    Single-use eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Bimatoprost 0.3mg/ml

    Single-use eye drops – patients who are allergic to preservative containing eye drops and for whom single-use latanoprost is not suitable

  • 11.6.3 Prostaglandin analogues and prostamides with timolol

    Recommended

  • Non-specialist or Specialist
    Latanoprost 50mcg/ml + timolol 5mg/ml

    Eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Travoprost 40mcg/ml + timolol 5mg/ml

    Eye drops – patients who are unable to tolerate latanoprost + timolol

  • Non-specialist or Specialist
    Bimatoprost 0.3mg/ml + timolol 5mg/ml

    Eye drops – patients who are unable to tolerate latanoprost + timolol

  • 11.6.3.1 Preservative Free

    Note: Preservative free eye drops may only be prescribed for patients who have a demonstrated allergy or intolerance to the preservative benzalkonium chloride

    Specific Indication

  • Non-specialist or Specialist
    Bimatoprost 0.3mg/ml + timolol 5mg/ml

    Single-use eye drops – patients who are allergic to preservative containing eye drops

  • 11.6.4 Sympathomimetics

    Recommended

  • Non-specialist or Specialist
    Brimonidine 0.2% eye drops
  • 11.6.4.1 With timolol

    Recommended

  • Non-specialist or Specialist
    Brimonidine 0.2% + timolol 0.5%

    Eye drops

  • 11.6.4.2 With brinzolamide

    Recommended

  • Non-specialist or Specialist
    Brimonidine 0.2% + brinzolamide 1%

    Eye drops

  • 11.6.5 Miotics

    Recommended

  • Non-specialist or Specialist
    Pilocarpine 1%, 2% or 4%

    Eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Pilocarpine 2% or 4%

    Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops

  • 11.6.6 Carbonic anhydrase inhibitors and systemic drugs

    11.6.6.1 Oral

    Recommended

  • Non-specialist or Specialist
    Acetazolamide

    (oral)

  • 11.6.6.2 Topical

    Recommended

  • Non-specialist or Specialist
    Dorzolamide 2%

    Eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Brinzolamide 10mg/ml

    Eye drops – patients who are unable to tolerate dorzolamide

  • Non-specialist or Specialist
    Dorzolamide 2%

    Single-use eye drops – patients who are allergic to preservative containing eye drops

  • 11.6.6.3 With Timolol

    Recommended

  • Non-specialist or Specialist
    Dorzolamide 2% & timolol 0.5%

    Eye drops

  • Specific Indication

  • Non-specialist or Specialist
    Brinzolamide 10mg/ml + timolol 5mg/ml

    Eye drops – patients who are unable to tolerate dorzolamide + timolol

  • Non-specialist or Specialist
    Dorzolamide 2% + timolol 0.5%

    Single-use eye drops – patients who are allergic to preservative containing eye drops

  • 11.7 Local anaesthetics

  • Non-specialist or Specialist
    Oxybuprocaine 0.4%

    Single use eye drops (Minims®)

  • 11.8 Miscellaneous ophthalmic preparations (inc. Dry Eye Guideline)

    11.8.1 Tear deficiency, ocular lubricants and astringents

    Treatment Guidelines

    Local Guideline: Dry Eye Syndromes

    Please note: Patients with mild dry eye disease should be directed to self-care with OTC preparations

    11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment

    Specific Indication

  • Non-specialist or Specialist
    Fluorescein 2%

    Single-use eye drops (Minims®)

  • Non-specialist or Specialist
    Ketorolac 0.5%

    Eye drops

  • Hospital or Specialist only
    Nepafenac 1mg/ml

    Eye drops – prophylaxis against postoperative macular oedema associated with cataract surgery in diabetic patients

  • Hospital or Specialist only
    Aflibercept
  • Hospital or Specialist only
    Bevacizumab
    • Wet age-related macular degeneration (off-label)
  • Hospital or Specialist only
    Brolucizumab
  • Hospital or Specialist only
    Faricimab

    • Diabetic macular oedema, as per NICE 799
    • Wet age-related macular degeneration, as per NICE TA800
  • Hospital or Specialist only
    Ocriplasmin

  • Hospital or Specialist only
    Ranibizumab
    • Age related macular degeneration, as per NICE TA155
    • Diabetic macular oedema, as per NICE TA274
    • Macular oedema (retinal vein occlusion), as per NICE TA283
    • Choroidal neovascularisation in people who also have pathological myopia, as per NICE TA298
  • 11.8.3 Other Miscellaneous Preparations

    Specific Indication

  • Hospital or Specialist only
    Adalimumab

    Non-infectious uveitis, as per NICE TA460

  • Specialist initiated or advised (with Shared Care Guideline)
    Ciclosporin
    • 1mg/ml eye drops (Ikervis®) – for treating severe keratitis in adult patients with dry eye disease that has not improved despite treatment with tear substitutes (see dry eye treatment guideline), as per NICE TA369. See Shared Care Guideline.
  • Hospital or Specialist only
    Ciclosporin
    • 1mg/ml eye drops (Verkazia®) - for treating severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents.
  • Hospital or Specialist only
    Holoclar®

    (Ex vivo expanded autologous human corneal epithelial cells containing stem cells) for treating limbal stem cell deficiency after eye burns, as per NICE TA467

  • Hospital or Specialist only
    Voretigene neparvovec

    Inherited retinal dystrophies caused by RPE65 gene mutations, as per NICE HST11

  • 11.9 Contact lenses

    Refer to BNF for recommendations regarding contact lenses and drug treatment.