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Area Prescribing Committee Formulary  
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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...
11.08.02  Expand sub section  Ocular diagnostic and peri-operative preparations and photodynamic treatment
11.08.02  Expand sub section  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  Expand sub section  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.
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Unlicensed Drug Unlicensed
Red
  • For use in the debridement of the corneal epithelium in patients with
    recurrent corneal erosion syndrome.
 
   
11.08.02  Expand sub section  Subfoveal choroidal neovascularisation
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  Expand sub section  Vitreomacular traction to top
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  Expand sub section  Other products - Mainly for treating ocular injuries
11.08.02.04  Expand sub section  Antifungals
11.08.02.04  Expand sub section  Cytotoxics / wound healing modulators
11.08.02.04  Expand sub section  Fibrinolytic drugs
11.08.02.04  Expand sub section  Glues - ocular to top
11.08.02.04  Expand sub section  Immunosuppressants
11.08.02.04  Expand sub section  Treatment of burns
Holoclar®
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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  Expand sub section  Visco-elastics
11.08.02.04  Expand sub section  Other
Ascorbic acid 10% Preservative-free eye drops
(Potassium ascorbate)
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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%)
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Unlicensed Drug Unlicensed
Red
 
   
Tretinoin 0.05% eye drops
(Retinoic acid)
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Unlicensed Drug Unlicensed
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.  

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