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).
0.25% and 0.5% eye drops. 0.25% and 0.5% unit dose eye drops.
0.25% and 0.5% long-acting eye drops.
Latanoprost eye drops
50 microgram/ml drops
50 microgram/ml preservative free SDU (Monopost)
Bimatoprost eye drops
Bimatoprost with Timolol eye drops
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
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
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.
Approved as a third line agent as an “add-on” in patients at the very end of medical management.
250mg tablets 500mg injection
Dorzolomide 2% with Timolol 0.5%
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.
Pilocarpine (eye drops)
0.5%, 1%, 2% and 4% eye drops.
1%, 2% and 4% unit dose eye drops.
Pilocarpine 1% and 2% eye drops
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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.
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.
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.
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.