North East and North Cumbria
ICS Formulary
 
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11 Eye

Preservative Free Eye Drops
Microbial contamination of multidose bottles of eye drops can cause eye infections that may lead to damage of the eye and in extreme cases loss of sight. To minimise the risk, multidose bottles of eye drops contain an antimicrobial preservative such as benzalkonium chloride. The preservatives used in eye drops are normally well tolerated, but they are not completely harmless. They can cause irritation and damage to the corneal epithelium. This risk is understood to be greater in patients with pre-existing damage to the ocular surface and where large quantities of preservative containing eye drops are applied repeatedly over a prolonged period (e.g. if applied more than 4 to 6 times daily for several weeks/ months).
To avoid these problems the use of preservative-free eye drops is recommended in:
 Patients who have experienced hypersensitivity reactions or irritation due to preservatives in eye drops.
 Patients who have received corneal grafts.
 Patients with conditions where there is already damage to the ocular surface as a result of disease or trauma, such as dry eye, blepharitis, ocular burns etc.
Treatment with preservative-free eye drops will usually be initiated by an ophthalmologist.

11-04-02 Other anti-inflammatory preparations

Antazoline 0.5% with Xylometazoline 0.05% Otrivine-Antistin®
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Ciclosporin 0.1% (1mg/1ml) Eye Drops
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  • Ikervis® - Approved for the treatment of dry eye disease in adults that has not improved despite treatment with artificial tears in line with NICE
  • Verkazia® - Approved for the treatment of severe vernal keratoconjunctivitis in children from 4 years of age and adolescents
Link  NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears

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Ketotifen Zaditen®
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Ophthalmology advice - atopic keratoconjunctivitis


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Olopatadine Opatanol®
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Sodium Cromoglicate 2% Eye drops
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  • A 2% preservative free preparation is also approved unlicensedunlicensed -  treatment to be imitated with the advice of an ophthalmologist only.

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Adalimumab
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  • 40mg Injection
  • Approved for the treatment of children with Severe Refractory Uveitis in line with interim NHS England Clinical Commissioning Policy.
  • Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy (replaces interim policy for adalimumab for adults with severe refractory uveitis from 24th October 2017)
Link  Adalimumab and Infliximab for Children with Severe Refractory Uveitis
Link  NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis

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Triamcinolone Acetonide Intracinol®
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  • 40mg in 1ml ophthalmic suspension injection

    • Approved for use in patients with pre-operative diabetic macular oedema (DMA) and epiretinal membrane undergoing vitreoretinal surgery




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