netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
 Formulary Chapter 11: Eye - Full Section


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 and details on their availability and use is available from the pharmacy at Newcastle’s Royal Victoria Infirmary (and on the North of Tyne and Gateshead Area Prescribing Committee’s website).

Numbers in brackets indicate counts of (Formulary items, Non Formulary items)
11.01 Administration of drugs to the eye (0,0)
11.02 Control of microbial contamination (0,0)
11.03 Anti-infective eye preparations (0,0)
11.03.01 Antibacterials (10,0)
11.03.02 Antifungals (4,0)
11.03.03 Antivirals (3,0)
11.04 Corticosteroids and other anti-inflammatory preparations (0,0)
11.04.01 Corticosteroids (13,0)
11.04.02 Other anti-inflammatory preparations (5,0)
11.05 Mydriatics and cycloplegics (0,0)
Antimuscarinics (7,0)
Sympathomimetics (2,0)
11.06 Treatment of glaucoma (0,0)
Beta-blockers (2,0)
Prostaglandin analogues (6,0)
Sympathomimetics (1,0)
Carbonic anhydrase inhibitors and systemic drugs (5,0)
Miotics (2,0)
11.07 Local anaesthetics (4,0)
11.08 Miscellaneous ophthalmic preparations (0,0)
11.08.01 Tear deficiency, ocular lubricants, and astringents (12,0)
11.08.02 Ocular diagnostic and peri-operative preparations and photodynamic treatment (0,0)
Ocular diagnostic preparations (3,0)
Ocular peri-operative drugs (9,0)
Subfoveal choroidal neovascularisation (4,0)
Vitreomacular traction (1,0) Other products - Mainly for treating ocular injuries (0,0)
Antifungals (0,0)
Cytotoxics / wound healing modulators (0,0)
Fibrinolytic drugs (0,0)
Glues - ocular (0,0)
Immunosuppressants (0,0)
Treatment of burns (1,0)
Visco-elastics (0,0)
Other (4,0)
11.09 Contact lenses (7,0)