BNF Chapter 11

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Ophthalmology

PRESCRIBE EYE PREPARATIONS GENERICALLY 

1 Allergic & inflammatory eye conditions
1.1 Allergic Conjunctivitis
ANTIHISTAMINES
ANTAZOLINE   & XYLOMETAZOLINE0.5% / 0.05% Eye Drops
KETOTIFEN250micrograms/ml PF Eye dropsPreservative Free

Dual action: MAST cell stabiliser and antihistamine

Restricted to Ophthalmologist prescribing.

Patients who have not been successfully treated in primary care and where reduced frequency of administration would aid compliance.

MAST-CELL STABILISERS
LODOXAMIDE Eye drops 0.1%
NEDOCROMIL SODIUM Eye drops 2%
SODIUM CROMOGLICATE Eye drops 2%
1.2 Immflammatory eye conditions
CORTICOSTEROIDSNOTES
BETAMETHASONE SODIUM PHOSPHATE Eye drops 0.1%, eye ointment 0.1%
DEXAMETHASONE

Eye drops 0.1%

Single-use preservative-free eye drop 0.1%

 

 

Intravitreal implant, 700micrograms

Restricted to Ophthalmology only, in line with NICE and/or local pathways. Funding is only available with the use of Blueteq initiation and continuation forms.

NICE TA460  Adalimumab and dexamethasone for treating non-infectious uveitis

APC traffic light status: RED

FLUOROMETHOLONE Eye drops 0.1%
PREDNISOLONE Eye drop s 0.5%, 1%

Single-use preservative free eye drops 0.5%

CORTICOSTEROIDS WITH ANTIBACTERIALS
BETAMETHASONE with NEOMYCIN Eye drops betamethasone 0.1%, neomycin 0.5%
DEXAMETHASONE + HYPROMELLOSE + NEOMYCINMAXITROL Eye drops, eye ointment

(0.1% / 0.5% / 0.35%)

DEXAMETHASONE with TOBRAMYCINTOBRADEX Eye drops  0.1% / 0.3%
PREDNISOLONE with NEOMYCIN Eye drops 0.5% / 0.5%
IMMUNOSUPPRESSANTS – Calcineurin inhibitors & related drugsNOTES
CICLOSPORIN 0.1% Eye DropsCiclosporin for treating dry eye disease that has not improved despite treatment with artificial tears [TA 369]
 2% Eye Drops (10ml)

0.2% Eye Ointment (3.5g)

UNLICENSED PREPARATIONS / CONSULTANT OPHTHALMOLOGIST ONLY

APC traffic light status: RED

ANTI-TNF ALPHANOTES
ADALIMUMABRESTRICTED for OPHTHALMOLOGY only in line with NICE guidelines and shared care parthway with terriary centre.

NICE TA460  Adalimumab and dexamethasone for treating non-infectious uveitis

APC traffic light status: RED

1.2a Anterior Uveitis
MYDRIATICS AND CYCLOPLEGICS (ANTIMUSCARINICS)NOTES
ATROPINE SULPHATEEye ointment 1%

Minims 1%

Uveitis / Iritis APC traffic light status: RED

Painful ciliary spasm APC traffic light status: BLUE

CYCLOPENTOLATEEye drops 0.5%, 1%

Minims 0.5%, 1%

Uveitis / Iritis APC traffic light status: RED

Painful ciliary spasm APC traffic light status: BLUE

2 Dry Eye Conditions
Surrey PCN Dry Eyes Management
RCO & UK-OPG Specials_Guidance 2014
RCO & UK-OPG Ophthalmic_Special_Order_Products 2014
OCULAR LUBRICANTS
ACETYLCYSTEINE  5 % Eye DropsRESTRICTED for patients with ‘filaments’
ILUBE Eye Drops
Surrey PCN Dry Eyes Management
 10%UNLICENSED PREPARATION / CONSULTANT OPHTHALMOLOGIST ONLY

APC traffic light status: RED

ACETYLCYSTEINE + HYPROMELLOSE5% + 0.35% Eye Drops
CARBOMER 980 (polyacrylic acid) 0.2% (eye gel = eye drops)Surrey PCN Dry Eyes Management
CARMELLOSE 0.5% Eye DropsSurrey PCN Dry Eyes Management
 0.5%, 1% Preservative Free Eye Drops Single Use Eye Drops
Surrey PCN Dry Eyes Management
HYPROMELLOSE 0.3 % Eye DropsSurrey PCN Dry Eyes Management
 0.3 % Preservative Free Eye Drops [6month expiry]
Surrey PCN Dry Eyes Management
LIQUID PARAFFIN eye ointment[6month expiry]
Surrey PCN Dry Eyes Management
SODIUM HYALURONATE 0.1% Preservative-Free Eye Drops

0.2% Preservative-Free Eye Drops

[6month expiry]
Surrey PCN Dry Eyes Management
3 Eye Infections
3.1 Bacterial Eye infections
ANTIBACTERIALS – AminoglycosidesNOTES
GENTAMICIN Eye/ear drops 0.3%

Preservative-free eye drops 1.5% (unlicensed)

PF 1.5% for bacterial keratatis only
ANTIBACTERIALS – Cephalosporins, second generationNOTES
CEFUROXIMEPreservative free eye drops 5% (unlicensed)

Intra-ocular injection 2mg in 0.2ml (unlicensed)

RESTRICTED for OPHTHALMOLOGY Team only
5% drops for Bacterial Keratitis OnlyIntra-ocular injection for Opthalmology consultant only
ANTIBACTERIALS – QuinolonesNOTES
CIPROFLOXACIN 0.3 % Eye DropsEye drops 0.3%
LEVOFLOXACINPreservative free single use eye drops 0.5% (minims) x 30RESTRICTED for OPHTHALMOLOGY CONSULTANTS only
MOXIFLOXACIN0.5% Preservative free (self preserving) 5ml eye dropsRESTRICTED for OPHTHALMOLOGY use only.

Bacterial conjunctivitis (2nd line or 1st line if severe)

Bacterial keratitis (OFF LABEL)

Post-op Endophthalmitis (OFF LABEL)

APC traffic light status: RED

ANTIBACTERIALS – OtherNOTES
CHLORAMPHENICOLEye drops 0.5%

Eye Ointment 1%

Single use preservative-free eye drops 0.5% (minims) 20 x 0.5ml

FUSIDIC ACIDEye drops 1%
VANCOMYCINPreservative free eye drops 5%(unlicensed)RESTRICTED for OPHTHALMOLOGY Team only
Bacterial Keratitis Only
Microbiology Guidance required
ANTIPROTAZOALS – OtherNOTES
PROPAMIDINE ISETHIONATEEye drops 0.1%
3.2 Viral Eye Infections
3.2a Opthalmic Herpes Simplex
ANTIVIRALS – Nucleoside AnaloguesNOTES
GANCICLOVIR 0.15% eye gelreplaces aciclovir 3% eye ointment (discontinued June 2019).

1st line for herpatic conjunctivitis and keratitis

ANTIVIRALS – OtherNOTES
TRIFLUOROTHIMIDINE1% eye dropsUNLICENSED PRODUCT (licensed in US)

2nd line for herpatic conjunctivitis and keratitis only when ganciclovir is unavailable. Not for sequential use.

4 Eye Procedures
ANTIMUSCARINICSNOTES
TROPICAMIDE Eye drops 1%

Minims 0.5%, 1%

ANTISEPTICS & DISINFECTANTS – Iodine ProductsNOTES
POVIDONE IODINE5% Eye Drops MINIMS Prophylaxis of ocular infections pre ocular surgery/intravitreal injection
OCULAR DIAGNOSTIC AGENTS – DyesNOTES
FLUORESCEIN SODIUM 2 % Minims (Eye drops)

1 % Minims (Eye drops)

 Detection of ocular lesions / foreign bodies
SYMPATHOMIMETICSNOTES
PHENYLEPHRINE Minims 2.5%, 10%
PHENYLEPHINE + TROPICAMIDEMYDRIASERT 5.4mg / 0.28mg Ophthalmic InsertPre-Op Mydriasis : 1 insert into the lower conjunctival sac up to max. 2 hours before procedure
Remove insert within 30 minutes of satisfactory mydriasis and within 2 hours of application
Patients with severe dry eyes may require a drop of saline to improve tolerance
OCULAR PERI-OPERATIVE PREPARATIONSNOTES
SODIUM HYALURONATE 10 mg / ml Healon Intra-ocular Injection 0.85ml

14 mg / ml Healon GV Intra-ocular Injection 0.85ml

Viscoelastic PE Ha-Luron 1.4% Intra-ocular injection 1ml

RESTRICTED for OPHTHALMOLOGY only
ACETYLCHOLINE CHLORIDE Intra-ocular Irrigation
SODIUM CHLORIDE 0.9% Eye Drops

0.9% (Minims) Eye Drops

 5% Eye Drops (10ml)

5% Preservative Free Eye Drops (10ml)

5% Eye Ointment (4g)

RESTRICTED for OPHTHALMOLOGY only
4.1 Post-operative pain & inflammation
LOCAL ANAESTHETICSNOTES
FLUORESCEIN + LIDOCAINE 0.25% /  4% eye dropsMINIMS
PROXYMETACAINE HYDROCHLORIDE 0.5 % Minims Eye dropsMINIMS
TETRACAINE  (Amethocaine)  1 % Minims (Eye drops)MINIMS
ANALGESICS – Non-steroidal-anti-inflammatory drugsNOTES
DICLOFENAC SODIUM 0.1 % Unit dose (Eye Drops)
KETOROLAC 0.5% Eye DropsRESTRICTED for OPHTHALMOLOGY only
5 Glaucoma & Ocular Hypertension
NICE Quality Standards GLAUCOMA
BETA-BLOCKERSNOTES
BETAXOLOL Eye drops 0.25%, 0.5%

Preservative-free 0.25%

LEVOBUNOLOL Eye drops 0.5%
TIMOLOL Eye drops 0.25%, 0.5%

Opthalmic gel-forming solution  0.25%, 0.5%

Preservative-free 0.25%, 0.5%

Gel-forming solution RESTRICTED for OPHTHALMOLOGY only
CARBONIC ANHYDRASE INHIBITORSNOTES
ACETAZOLAMIDE 250mg TABLETS

250mg SR

500 mg Injection

BRINZOLAMIDE 10mg/ml Eye Drops
DORZOLAMIDE 2 % Eye Drops
DORZOLAMIDE  + TIMOLOL 2 % / 0.5% Eye Drops

2 % / 0.5% Preservative-free Eye Drops

 

Preservative free for patients who cannot tolerate preserved formulations

MIOTICS – parasympathomimeticsNOTES
PILOCARPINE 0.5%, 1%, 3% & 4%Eye Drops

2%, 4% Eye drop minims

PROSTAGLANDIN ANALOGUES & PROSTAMIDESNOTES
BIMATOPROST100mcg/ml Eye Drops

300 mcg/ml Eye Drops

RESTRICTED for OPHTHALMOLOGY only
BIMATOPROST / TIMOLOL300 mcg/ml + 5mg/ml Eye Drops

Preservative Free 300 mcg/ml + 5mg/ml unit dose Eye Drops

RESTRICTED for OPHTHALMOLOGY only
LATANOPROST50 mcg/ml Eye DropsAPC traffic light status: GREEN
Preservative-free 50mcg/ml eye drop 0.2ml minimsFor use in patients with allergy to preservative only.
LATANOPROST / TIMOLOL50 mcg/ml+ 5mg/ml Eye DropsAPC traffic light status: GREEN
SYMPATHOMIMETICS – Alpha– adrenoceptor agonistsNOTES
APRACLONIDINE 

1% eye drop dose units (PF)

 

RESTRICTED for OPHTHALMOLOGY only

Prevention of postoperative elevation of intraocular pressure after anterior segment laser

 

0.5% eye drops3rd line short term adjunctive treatment
BRIMONIDINE 0.2% Eye Drops
6 Retinal disorders
ANTINEOVASCULARISATION DRUGS – Vascular endothelial growth factor inhibitorsNOTES
AFLIBERCEPT (Eylea) 40mg/ml
Intravitreal Injection (0.1ml vial)
RESTRICTED for OPHTHALMOLOGY only (PbRE)Surrey PCN [Eylea for wet AMD]NICE TAG Eylea (2013)

NICE TA 409 (branch retinal vein occlusion)
SMC Approval EyleaSurrey PCN wet AMD Sequential Therapy REJECTED

NICE TA486:Aflibercept for treating choroidal neovascularisation

PCN Policy Statement: Aflibercept for choroidal neovascularisation

APC traffic light status: RED


BEVACIZUMAB (Avastin) 
RESTRICTED for OPHTHALMOLOGY only
PbR Excluded  – Requires CCG Funding
PCN Policy Statement: Bevacizumab for the treatment of uveitisOff-label use

Uveitis APC traffic light status: RED

RANIBIZUMAB (Lucentis)  10mg/ml
Intravitreal Injection (0.23ml vial)
RESTRICTED for OPHTHALMOLOGY only (PbRE)NICE TAG for wet AMD (2008)

 
NICE TAG DMONICE TAG RVOSurrey PCN [Ozurdex 1st line for CRVO]
NICE TAG pathological myopiaSurrey PCN Lucentis Myopic Surrey PCN wet AMD Sequential Therapy REJECTEDAPC traffic light status: RED
6.2 Macular Oedema
CORTICOSTEROIDSNOTES
FLUOCINOLONE ACETONIDE (Iluvien) 190microgram Implant


Intravitreal Implant (releases 0.2micrograms/day for ~3years)

RESTRICTED for OPHTHALMOLOGY only (PbRE)
NICE TA 590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitisAPC Policy statement: 2019 Fluocinolone in uveitis‘BLACK’ for intravitreal implant for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy. Fluocinolone acetonide is not on the formulary for this indication.APC Policy statement: Fluocinolone DMO phakic TA613APC traffic light status: RED
6.4 Vitreomacular Traction
RECOMBINAT PROTEOLYTIC ENZYMESNOTES
OCRIPLASMIN (Jetrea)  0.5mg/0.2ml
Intravitreal Injection
RESTRICTED for OPHTHALMOLOGY only (PbRE)
NICE TAG for Ocriplasmin
APC traffic light status: RED
OTHER – chalating agents
CHELATING AGENTSNOTES
DISODIUM EDETATE 0.4% solutionRESTRICTED for OPHTHALMOLOGY surgery

Band Keratopathy

UNLICENSED PRODUCT

 

1. Gastro-Intestinal System | 2. Cardiovascular System | 3. Respiratory System | 4. Central Nervous System | 5. Antimicrobials | 6. Endocrine System | 7. Obstetrics, Gynaecology & Urology | 8. Malignant Disease & Immunosuppression | 9. Nutrition & Blood | 10. Musculoskelatal & Joint Diseases | 11. Opthalmology | 12. Ear, Nose & Oropharynx | 13. Dermatology | 14. Immunology & Vaccines | 15. Anaesthetics |  GP Centre Home