1.1 Allergic conjunctivitis

• Sodium Cromoglicate 2% Eye Drops – prescribe as Opticrom® in primary care 10ml (most cost effective size)

1.2 Inflammatory eye conditions

Corticosteroids

The severity of the inflammation determines the choice of steroid.

Topical steroids should not be used for undiagnosed red eye. If red eye is due to herpes simplex, corticosteroids will aggravate this condition possibly leading to loss of vision or even loss of the eye.

• Prednisolone acetate 1% Eye Drops (most potent)
• Dexamethasone 0.1% Eye Drops
• Betamethasone 0.1% Eye/Ear/Nose Drops – prescribe as Vistamethasone® brand in primary care
• Prednisolone sodium phosphate 0.5% eye drops
• Fluorometholone eye drops* (least potent)
• Loteprednol 0.5% eye drops – ✓ Specialist Initiation Only

* Steroid eye drops can raise intra-ocular pressure (IOP) and therefore precipitate glaucoma in patients pre-disposed to chronic simple glaucoma. Evidence suggests that fluorometholone is less likely to raise IOP though this may be due to reduced penetration of the cornea.

Corticosteroid Combinations with Anti-Infectives

• Dexamethasone (Maxitrol®) Eye Drops ✓ First Choice
• Betamethasone (Betnesol-N®) 0.1% Eye/Ear/Nose Drops

Antimuscarinincs

• Cyclopentolate 0.5% and 1% Eye Drops (5ml) ✓ First Choice or
• Minims Atropine 1% PF ensure Minims is prescribed

Mild dry eye

• Hypromellose 0.3% Eye Drops
• Carmellose
  • VIZcellose® 0.5% /1% p/f eye drops Stable for 3 months after opening and replaces Celluvisc®
• Paraffins
  • Xailin Night® Gel pf

Moderate dry eye

• Sodium Hyaluronate
  • Blink Intensive Tears (0.2%) pf
  • Eyeaze® pf (in place of Hylotears®/Hyloforte®/Xailin® HA in primary care)
  • Optive fusion®

Meibiamian Gland Deficiency

• Systane Balance® ✓ Specialist Initiation Only

Severe dry eye

• Ciclosporin 0.1% eye drops (Ikervis®) ✓ Specialist Initiation Only

3.1 Bacterial eye infection

Antibacterials

• Chloramphenicol 1% Eye Ointment Available via Pharmacy First
• Chloramphenicol 0.5% Eye Drops Available via Pharmacy First
• Propamidine 0.1% Eye Drops (Brolene®)

Antibacterials - Aminoglycosides

• Gentamicin 0.3% Eye/Ear Drops

Antibacterials - Cephalosporins

• Cefuroxime topical drops

Antibacterials - Macrolides

• Azithromycin 15mg/g Eye Drops pf

Antibacterials -Quinolones

• Ciprofloxacin 0.3% Eye Drops
• Ofloxacin 0.3% eye drops

Antiprotozoals

• Seek specialist advice

3.2 Viral eye infection

• Ganciclovir 0.15% Eye gel

Antimuscarinics

• Minims Tropicamide 1% Eye Drops

Antiseptics and Disinfectants – Iodine Products

• Minims Povidone Iodine 5%

Diagnostic Agents – Dyes

• Minims Fluorescein 1%
• Minims Fluorescein 2%

Miotics – Parasympathomimetics

• Acetylcholine 20mg Powder & Solvent for Intraocular Irrigation – Miochol E

Sympathomimetics – Vasoconstrictor

• Minims Phenylepherine 2.5%
• Minims Phenylepherine 10%

4.1 Post-operative pain and inflammation

Anaesthetics – Local

• Minims Tetracaine 1%
• Minims Fluorescein with Lidocaine
• Minims Proxymetacaine 0.5%

Anaesthetics – Non Steroidal Anti-Inflammatory Drugs

• Ketorolac 0.5% Eye Drops
• Nepafanac 1% eye drops – as per SMC advice – for the reduction in risk of post operative macular oedema associated with cataract surgery in diabetic patients.

Beta-adrenoceptor blockers

• Timolol 0.25% Eye Drops
• Timolol 0.5% Eye Drops

Carbonic Anhydrase Inhibitors

• Acetazolamide 250mg Tablets
• Acetazolamide 250 MR Capsules
• Acetazolamide 500mg powder for solution for injection vials
• Dorzolamide 20mg/ml eye drops
• Brinzolamide 10mg/ml eye drops

Combination products

• Dorzolamide/Timolol ✓ First Choice
• Brinzolamide/timolol (Azarga®) Azarga® allows patient to administer fewer drops compared to separate administrations

Miotics

Parasympathomimetics

• Pilocarpine 1% or 2%

Prostaglandin analogues and Prostamides

• Travoprost 40mcg/ml eye drops
• Latanoprost 50micrograms/ml eye drops

Combination products

• Latanoprost 50mcg/ml with Timolol 5mg/ml eye drops

Sympathomimetics - Alpha2-adrenoceptor agonists

• Brimonidine 0.2% eye drops
• Apraclonidine 5% eye drops

Brimonidine should not be used by patient on tricyclic antidepressants or MAOIs, on in those under 5 years of age.

Combination products

• Brimonidine 2mg/ml with Timolol 5mg/ml

Preservative free drops

Formulations with preservative are significantly cheaper than preservative-free preparations.

• Latanoprost minims (Monopost®) SMC restricted to proven sensitivity to BAK preservative)
• Latanoprost/timolol (Fixapost®) UD SMC restricted to proven sensitivity to preservative
• Eylamdo® PF (dorzolamide/timolol) multidose bottle can be considered in those requiring this combination who have a proven sensitivity to BAK. Multi dose bottle are less expensive than single dose vials.
• Eydelto® PF (dorzolamide) multidose bottle can be considered in those with a proven sensitivity to BAK. Multidose bottle are more cost effective than single dose vials.

6.1 Macular degeneration

• Aflibercept (Eylea®) ✓ Specialist Use Only
• Ranibizumab (Lucentis®) ✓ Specialist Use Only

6.2 Macular oedema

• Aflibercept (Eylea®) ✓ Specialist Use Only
• Ranibizumab (Lucentis®) ✓ Specialist Use Only
• Dexamethasone (Ozurdex®) as per SMC ✓ Specialist Use Only
• Fluocinolone (Iluvien®) – IPTR as per local protocol ✓ Specialist Use Only