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11: Eye

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

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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

  • Chloramphenicol 0.5%

    Eye drops

  • Chloramphenicol 1%

    Eye ointment

    • Alternative

  • Ciprofloxacin 0.3%

    Eye drops

  • Fusidic acid 1%

    Eye drops in gel basis

  • Gentamicin 0.3%

    Eye drops

  • Ofloxacin 0.3%

    Eye drops

    • Specific Indication

  • Gentamicin 1.5%

    Eye drops – hospital only

  • 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

  • Aciclovir 3%

    Eye ointment

    • 11.4 Corticosteroids and other anti-inflammatory preparations

    11.4.1 Corticosteroids

    Recommended

  • Betamethasone 0.1%

    Eye drops or ointment

  • Prednisolone 0.5%

    Eye drops (Predsol®)

  • Prednisolone 1%

    Eye drops (Pred Forte®)

  • Dexamethasone 0.1%

    Eye drops (Maxidex®)

  • Dexamethasone 0.1% & tobramycin 0.3%

    Eye drops (Tobradex®)

    • Specific Indication

  • Prednisolone 0.5%

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

  • Dexamethasone 0.1%

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

  • 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

  • Dexamethasone

    Intravitreal implant

  • Fluocinolone acetonide

    Intravitreal implant

    • 11.4.3 Other anti-inflammatory preparations

    Recommended

  • 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

  • Olopatadine

    Eye drops

    Second-line when sodium cromoglicate is ineffective

  • 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

  • Cyclopentolate 0.5% or 1%

    eye drops

    • Specific Indication

  • Cyclopentolate 0.5% or 1%

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

  • Tropicamide 0.5% or 1%

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

    • 11.5.2 Sympathomimetics

    Recommended

  • Phenylephrine 2.5%

    Single-use eye drops (Minims®)

    • Specific Indication

  • Mydriasert®

    Tropicamide and phenylephrine ophthalmic insert.

    Restricted to use prior to cataract surgery.

  • 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

  • Timolol 0.25% or 0.5%

    Eye drops

    • Alternative

  • Betaxolol 0.5%

    Eye drops

    • Specific Indication

  • 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

  • Latanoprost 50mcg/ml

    Eye drops

    • Specific Indication

  • Travoprost 40mcg/ml

    Eye drops – patients who are unable to tolerate latanoprost

  • 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

  • Latanoprost 50mcg/ml

    Single-use eye drops

    • Specific Indication

  • 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

  • Latanoprost 50mcg/ml + timolol 5mg/ml

    Eye drops

    • Specific Indication

  • Travoprost 40mcg/ml + timolol 5mg/ml

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

  • 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

  • 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

  • Brimonidine 0.2% eye drops

    • 11.6.4.1 With timolol

    Recommended

  • Brimonidine 0.2% + timolol 0.5%

    Eye drops

    • 11.6.4.2 With brinzolamide

    Recommended

  • Brimonidine 0.2% + brinzolamide 1%

    Eye drops

    • 11.6.5 Miotics

    Recommended

  • Pilocarpine 1%, 2% or 4%

    Eye drops

    • Specific Indication

  • 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

  • Acetazolamide

    (oral)

    • 11.6.6.2 Topical

    Recommended

  • Dorzolamide 2%

    Eye drops

    • Specific Indication

  • Brinzolamide 10mg/ml

    Eye drops – patients who are unable to tolerate dorzolamide

  • Dorzolamide 2%

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

    • 11.6.6.3 With Timolol

    Recommended

  • Dorzolamide 2% & timolol 0.5%

    Eye drops

    • Specific Indication

  • Brinzolamide 10mg/ml + timolol 5mg/ml

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

  • Dorzolamide 2% + timolol 0.5%

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

    • 11.7 Local anaesthetics

  • 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

    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

  • Fluorescein 2%

    Single-use eye drops (Minims®)

  • Ketorolac 0.5%

    Eye drops

  • Nepafenac 1mg/ml

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

  • Aflibercept
  • Bevacizumab
    • Wet age-related macular degeneration (off-label)
  • Brolucizumab
  • Faricimab

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

  • 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

  • Adalimumab

    Non-infectious uveitis, as per NICE TA460

  • 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.
  • Ciclosporin
    • 1mg/ml eye drops (Verkazia®) - for treating severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents.
  • 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

  • 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.

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    Key

    Hospital / Specialist only

    Specialist initiated / advised (with Shared Care Guideline)

    Specialist initiated / advised (without Shared Care Guideline)

    Non-specialist or Specialist

    Treatment Guidelines

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