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 Formulary Chapter 11: Eye - Full Chapter
Notes:

NORTH OF TYNE AND GATESHEAD GUIDELINES FOR MANAGEMENT OF COMMON OPHTHALMOLOGIAL CONDITIONS IN PRIMARY / COMMUNITY CARE

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).

 Details...
11.01  Administration of drugs to the eye
11.02  Control of microbial contamination
11.03  Anti-infective eye preparations
11.03.01  Antibacterials
Chloramphenicol 0.5% eye drops & ointment
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First Choice
Green
  • Preservative-free eye drops are also approved for use:
    • 0.5% preservative-free Minims® - first choice.
    • 0.5% preservative-free eye drops unlicensedunlicensed - approved only for patients who are unable to use Minims®due to dexterity problems

 
Fusidic Acid (Fucithalmic®)
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Alternatives
Green
 
   
Gentamicin 0.3% ear/eye drops & 0.3% Minims®
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • 1.5% eye drops with and with out preservative are also approved -  unlicensedunlicensed and Red Traffic Light
 
   
Ofloxacin 0.3% Eye drops
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Alternatives
Green
 
   
Propamidine Isetionate
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Alternatives
Green
  • For use in the treatment of acanthamoeba keratitis – used with PHMB.
 
   
Benzylpenicillin 0.3% Eye drops
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Unlicensed Drug Unlicensed
Red
 
   
Cefuroxime 5% eye drops
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Unlicensed Drug Unlicensed
Red
 
   
Erythromycin 0.5% Eye ointment
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
Polyhexamethylene biguinide (PHMB) 0.02% Eye drops
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
Povidone iodine 5%
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
11.03.02  Antifungals to top
 note 

There are currently no licensed topical antifungal agents available for the treatment of eye infections. Products such as those below can be obtained as unlicensed medicines to meet specific needs on request from an ophthalmologist or microbiologist. Contact pharmacy at the RVI (0191 2825398) for details.

Amphotericin B Preservative-free
(eye drops)
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Unlicensed Drug Unlicensed
Red
  • 0.1% and 0.3% eye drops.
 
   
Econazole 1% Eye drops
(In arachis oil)
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Unlicensed Drug Unlicensed
Red
 
   
Natamycin 5%
(eye drops)
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Unlicensed Drug Unlicensed
Red
 
   
Voriconazole
(eye drops)
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
  • 100microgram in 0.1ml (0.1%) - preservative-free eye drops.
 
   
11.03.03  Antivirals
Aciclovir 3% eye ointment
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Formulary
Green
 
   
Aciclovir 800mg Tablets
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Formulary
Green
  • For the treatment of ophthalmic zoster.
 
   
Trifluorothymidine 1% Eye drops
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
11.04  Corticosteroids and other anti-inflammatory preparations
11.04.01  Corticosteroids
Betamethasone 0.1% eye drops & eye ointment
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First Choice
Green
 
Prednisolone 0.5% with Neomycin 0.5% (Predsol-N®)
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Formulary
Green
 
   
Betamethasone 0.1% with Neomycin 0.5% eye drops
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Alternatives
Green
 
   
Dexamethasone 0.1% eye drops (Maxidex®)
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Alternatives
Green
  • Preservative-free eye drops are also approved.
    • 0.1% Minims® - first choice.
    • 0.1% preservative free eye drops unlicensedunlicensed - approved only for patients who are unable to use Minims®due to dexterity problems.

 
   
Dexamethasone 0.1% Preservative-free
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Alternatives
Green

First choice

Unit dose vials (Minims®)

Alternative

Eye drops (unlicensed) - only for patients who are unable to use Minims® due to dexterity problems

 
   
Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
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Alternatives
Green
  • Eye drops and eye ointment
 
   
Fluorometholone 0.1% Eye drops (FML®)
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Alternatives
Green plus
  • For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist.
 
   
Loteprednol Eye drops
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Alternatives
Green plus
  • Approved as a second line agent to conventional corticosteroid eye drops, treatment to be imitated with the advice of an ophthalmologist only.
 
   
Prednisolone 0.5% Single Use Minims®
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Alternatives
Green
 
   
Prednisolone eye drops
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Alternatives
Green
  • The following formulations are approved
    • 0.5% eye drops and 1% (Pred-Forte).
    • 0.1% and 0.3% eye drops - both unlicensedunlicensed.

  • Approved preservative free formulations include
    • 0.5% minims.
    • 0.1%, 0.3%, 0.5% and 1% - all unlicensedunlicensed.

 
   
Rimexolone
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Alternatives
Green plus
  • For use where Fluorometholone (FML) drops (which are much cheaper) are likely to be insufficiently effective.

 
   
Dexamethasone 700 microgram intravitreal implant (Ozurdex®)
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Alternatives
Red
High Cost Medicine
  • Approved for macular oedema following central retinal vein occlusion
    in line with NICE.
  • Approved for treating diabetic macular oedema in line with NICE.
  • Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy
 
Link  NICE TA229 Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion
Link  NICE TA349: Diabetic Macular Oedema
Link  NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis
   
Fluocinolone 190 microgram intravitreal implant
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Alternatives
Red
High Cost Medicine
  • Recommended as a possible treatment for people with chronic diabetic macular oedema who have an artificial lens in their eye if the implant is used in the eye with the artificial lens and their diabetic macular oedema has not got better with other treatments - in line with NICE.
 
Link  NICE TA301Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
   
11.04.02  Other anti-inflammatory preparations
Antazoline 0.5% with Xylometazoline 0.05% (Otrivine-Antistin®)
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Formulary
Green
 
   
Ciclosporin 0.1% (1mg/1ml) Eye Drops
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Ikervis®

  • Approved as a possible treatment for people with dry eye disease that has not improved despite treatment with artificial tears NICE. Green

Verkazia®

  • Approved for the treatment of severe vernal keratoconjunctivitis in children and adolescents. Green plus
  • If treatment is longer than 12 months then 3-6 monthly reviews will be required. 

 

  • A 0.2% eye ointment is also approved as an alternative to eye drops for this indication Red Traffic Light  and unlicensedunlicensed.
 
Link  TA 369 Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
   
Olopatadine (Opatanol®)
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Formulary
Green
 
   
Sodium Cromoglicate 2% Eye drops
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Formulary
Green
  • A 2% preservative free preparation is also approved unlicensedunlicensed -  treatment to be imitated with the advice of an ophthalmologist only.
 
   
Adalimumab  (Humira®)
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Formulary
Red
High Cost Medicine
  • 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 adults 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 for Children with Severe Refractory Uveitis
Link  NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis
   
11.05  Mydriatics and cycloplegics to top
11.05  Antimuscarinics
Atropine
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Formulary
Green
  • 1% eye drop.
    1% ointment.
    1% preservative-free eye drops unlicensedunlicensed.
 
   
Atropine Sulphate Single Use Minims®
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Formulary
Green
 
   
Cyclopentolate Eye drops
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Formulary
Green
  • 0.5% and 1%.
 
   
Cyclopentolate Single Use Minims®
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Formulary
Green
  • 0.5% and 1%.
 
   
Mydricaine ® No.2
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Formulary
Red
  • 0.3ml injection containing procaine HCl 6mg, atropine sulphate 1mg and adrenaline solution (1:1,000)
 
   
Phenylephrine
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Formulary
Green
  • 2.5% eye drops unlicensedunlicensed
  • 2.5% single use Minims®
 
   
Tropicamide single use Minims®
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Formulary
Green
 
   
11.05  Sympathomimetics
Phenylephrine Hydrochloride
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Formulary
Green
  • 2.5% eye drops unlicensedunlicensed.
  • 2.5% single use Minims®.
 
   
Mydricaine® No.2
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Formulary
Red
  • 0.3ml injection containing procaine HCL 6mg, atropine sulphate 1mg and adrenaline solution (1 in 1,000).
 
   
11.06  Treatment of glaucoma
11.06  Beta-blockers
Timolol
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Formulary
Green
  • 0.25% and 0.5% eye drops.
    0.25% and 0.5% unit dose eye drops.
 
   
Timolol LA
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Formulary
Green
  • 0.25% and 0.5% long-acting eye drops.
 
   
11.06  Prostaglandin analogues to top
Latanoprost eye drops
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First Choice
Green
  • 50 microgram/ml drops
  • 50 microgram/ml preservative free SDU (Monopost)
 
Bimatoprost eye drops
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Alternatives
Green
 
   
Bimatoprost with Timolol eye drops
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Alternatives
Green
  • For use as a second/third-line agent in patients insufficiently responsive
    to monotherapy with a prostaglandin analogue or beta blocker
 
   
Latanoprost 0.005% with Timolol 0.5% eye drops
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Alternatives
Green
  • For use as a second/third-line agent in patients insufficiently responsive
    to monotherapy with a prostaglandin analogue or beta blocker.
 
   
Tafluprost (Preservative Free) 15micrograms/ml unit dose eye drops
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Alternatives
Green plus
  • Approved for use in children and adults. To be initiated by ophthalmologists only and is to be used third line after preservative containing latanoprost and preservative free timolol. The ophthalmologists must clearly document that signs and symptoms of preservative intolerance/ allergy have been demonstrated in their patient prior to initiation.
 
   
Tafluprost 15microg with timolol 0.5% eye drops
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Alternatives
Green
 
   
11.06  Sympathomimetics
Brimonidine Tartrate 0.2% eye drops
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
11.06  Carbonic anhydrase inhibitors and systemic drugs
Brinzolamide
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First Choice
Green
  • 1% eye drops.
 
Dorzolomide
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First Choice
Green
  • 2% eye drops.
  • 2% unit dose eye drops.
 
Brinzolamide 10mg/ml & brimonidine 2mg/ml (Simbrinza®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Approved as a third line agent as an “add-on” in patients at the very end of medical management.
 
   
Acetazolamide
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Alternatives

250mg tablets Green Traffic Light
500mg injection Red Traffic Light

 
   
Dorzolomide 2% with Timolol 0.5%
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • Eye drops and unit dose eye drops
  • Approved for use in patients with confirmed allergy presenting as
    conjunctival changes or skin allergy. To be initiated by ophthalmologists
    only. The ophthalmologists must clearly document that signs and
    symptoms of preservative allergy have been demonstrated in their
    patient prior to initiation.
 
   
11.06  Miotics
Pilocarpine
(eye drops)
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Third Choice
Green
  • 0.5%, 1%, 2% and 4% eye drops.
  • 1%, 2% and 4% unit dose eye drops.
 
   
Pilocarpine 1% and 2% eye drops
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
11.07  Local anaesthetics
Lidocaine 4% with Fluorescein 0.25% Minims®
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Oxybuprocaine 0.4% Minims®
(Benoxinate)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Proxymetacaine 0.5% Minims®
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Tetracaine 1% Minims®
(Amethocaine)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
11.08  Miscellaneous ophthalmic preparations to top
11.08.01  Tear deficiency, ocular lubricants, and astringents
Hypromellose
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • 0.3% eye drops
  • 0.3% preservative-free eye drops:
    • 1st line Tear-Lac®;
    • 2nd line PF Drops®
      -treatment to be initiated on the advice of ophthalmologist only

 
Acetylcysteine 5% with Hypromellose 0.35%
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Balanced Salt Solution
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Alternatives
Red
  • Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags.
  • For intra-ocular or topical irrigation during surgical procedures.
 
   
Carbomer 980 eye drops
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Alternatives
Green
  • Viscotears® eye drops
  • GelTears® single unit dose eye drops
 
   
Carmellose sodium
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Alternatives
Green
  • 0.5% and 1% eye drops.
 
   
Duolube® eye ointment
(Lanolin and preservative free)
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Alternatives
Green plus
  • Please note
    The brand name will soon change to Sooth Night-time and Duolube will be unable to be ordered
 
   
Liquid Paraffin eye ointment
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Retinol palmitate 250iu/g, liquid paraffin, white soft paraffin, wool fat
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • 5g eye ointment
 
   
Sodium Chloride
 Track Changes
Alternatives
Green
  • 0.9% eye drops and single dose unit eye drops.
  • 5% eye drops and preservative-free eye drops.
  • 5% eye ointment unlicensedunlicensed.
 
   
Sodium Hyaluronate
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • 0.1% eye drops & preservative-free eye drops
  • 0.2% eye drops & preservative-free eye drops
  • 0.4% unit dose vials (Clinitas) & 0.4% preservative-free eye drops (Clinitas Multi) Green+ Traffic Light  - specialist recommendation for the treatment of Keraconjunctiva sicca, post refractive surgery and Corneal healing disorders.
 
   
Systane®
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Alternatives
Green
  • 10ml multidose bottles 0.8ml preservative-0free vials Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients).
  • Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. The multidose bottle may be used for up to six months after opening in primary care. In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.
 
   
Acetylcysteine 5% eye drops and preservative eye drops
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Unlicensed Drug Unlicensed
Green plus
 
   
11.08.02  Ocular diagnostic and peri-operative preparations and photodynamic treatment
11.08.02  Ocular diagnostic preparations
Fluorescein
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Formulary
Green plus
  • 2% minims eye drops
  • 1mg ophthalmic strips
  • Fluorets
  • 10% 5ml & 20% 5ml injections unlicensedunlicensed
 
   
Lissamine Green
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Formulary
Red
1.5mg ophthalmic strips 
   
Indocyanine green
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Unlicensed Drug Unlicensed
Red

25mg injection.

 
   
11.08.02  Ocular peri-operative drugs
Diclofenac
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Formulary
Red
  • 0.1% eye drops and unit dose eye drops.
  • For post-operative inflammation limited to patients where corticosteroids are unsuitable.
 
   
Acetylcholine Chloride
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Formulary
Red
  • 20mg in 2ml injection.
 
   
Apraclonidine
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Formulary
Green
  • 0.5% and 1% ophthalmic solution.
 
   
Hydroxypropylmethylcellulose HV (Oasis®)
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Formulary
Red
  • 2% 2.3ml intraocular injection.
 
   
Ketorolac (Acular®)
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Formulary
Green
  • 0.5% eye drops.
 
   
Povidone iodine 5% eye drops
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Formulary
Red
  • For use in eye surgery only. 
 
   
Sodium Hyaluronate
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Formulary
Red
  • 10mg in 1ml bag (Z-Hyalin®, formerly Ophthalin Gelbag®)
  • 14mg in 1ml syringe (Healon GV®)
 
   
Duovisc® Injection
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Unlicensed Drug Unlicensed
Red
  • Injection for use in cataract surgery containing VisCoat (1% sodium hyaluronate) and ProVisc (3% sodium hyaluronate, 4% chondroitin sulphate).
 
   
Ethanol 20% eye drops.
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
  • For use in the debridement of the corneal epithelium in patients with
    recurrent corneal erosion syndrome.
 
   
11.08.02  Subfoveal choroidal neovascularisation to top
Aflibercept 4mg/0.1ml injection (Eylea®)
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Formulary
Red
High Cost Medicine
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for macular oedema – central retinal vein occlusion in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE.
  • Approved as an option for treating visual impairment because of myopic choroidal neovascularisation in adults in line with NICE
 
Link  NICE TA 294 Aflibercept solution for injection for treating wet age‑related macular degeneration
Link  NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA 346 Aflibercept for treating diabetic macular oedema
Link  NICE TA 409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
Link  NICE TA 486: Aflibercept for treating choroidal neovascularisation
   
Ranibizumab 10mg/1ml injection (Lucentis®)
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Formulary
Red
High Cost Medicine
  • Approved for wet age related macular degeneration in line with NICE/.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for visual impairment caused by macular oedema secondary
    to retinal vein occlusion in line with NICE.
  • Approved as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia in line with NICE.
 
Link  NICE TA 155 Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA 274 Ranibizumab for treating diabetic macular oedema
Link  NICE TA 283 Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA 298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
   
Verteporfin 15mg Injection (Visudyne®)
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Formulary
Red
High Cost Medicine

Approved for photodynamic therapy in wet age-related macular degeneration in line NICE.

 
Link  NICE TA68: Photodynamic therapy for age related macular degeneration
   
Bevacizumab 1.25mg/0.5ml intravitreal injection
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Unlicensed Drug Unlicensed
Red
  • NETAG approved for use in the management of macular oedema
    secondary to retinal vein occlusion. This is considered a more cost
    effective treatment option in RVO compared with ranibizumab.
  • NTAG approved for age related macular degeneration.
 
   
11.08.02  Vitreomacular traction
Ocriplasmin (Jetrea®)
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Formulary
Red
High Cost Medicine
  • Approved for use in patients with vitreomacular traction who also have no epiretinal membrane and a hole (up to 400 micrometres) in the centre of their retina or severe sight problems in line with NICE.
 
Link  NICE TA 297 Ocriplasmin for treating vitreomacular traction
   
11.08.02.04  Other products - Mainly for treating ocular injuries
11.08.02.04  Antifungals
11.08.02.04  Cytotoxics / wound healing modulators
11.08.02.04  Fibrinolytic drugs to top
11.08.02.04  Glues - ocular
11.08.02.04  Immunosuppressants
11.08.02.04  Treatment of burns
Holoclar®
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
  • Approved for treating limbal stem cell deficiency after eye burns in line with NICE and NHS England Commissioning Policy as of 14 November 2017
 
   
11.08.02.04  Visco-elastics
11.08.02.04  Other to top
Ascorbic acid 10% Preservative-free eye drops
(Potassium ascorbate)
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
Disodium edetate 0.37% solution
(20ml)
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Unlicensed Drug Unlicensed
Red
 
   
Sodium Citrate 10.11% eye drops
(equivalent to citrate 6.5%)
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
Tretinoin 0.05% eye drops
(Retinoic acid)
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
 
   
11.09  Contact lenses
 note 

Contact lenses are only provided on the NHS when there is a medical need. Usually this is when vision cannot be improved with spectacles, but can be improved with
contact lenses. The contact lens clinical staff at the RVI will assess eligibility. Examples of eligibility include some disorders of the cornea, very high prescriptions and
'bandage' lenses.

The following contact lens care products stocked for the care of contact lenses for patients attending the ophthalmology department at the RVI. GPs are not allowed to
prescribe contact lens solutions on the NHS.

Alcon Optifree® Express System
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Bausch & Lomb contact lens solution (Boston®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Bausch & Lomb saline (Salette®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Clens 100®
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Miraflow® daily cleaner
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Oxysept® 1 Step
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Systane®
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.   

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

netFormulary