Eye
Anti-infective eye preparations
NB: * denotes preservative free preparations
11.3.1 Antibacterials
Treatment of minor eye infections in primary care should be restricted to chloramphenicol +/- Fucithalmic®. If not resolving after 48 hours contact Acute Referral Clinic (GP line: 01202 726039)
For all infected eyes: if patient is experiencing pain +/- visual disturbance refer the same day
First line: chloramphenicol drops 0.5%,* Minims® chloramphenicol 0.5%, chloramphenicol ointment 1%
Second line: fusidic acid m/r drops 1%, gentamicin drops 0.3%
For specialist initiation: ofloxacin drops 0.3%, ciprofloxacin ointment 0.3%, propamidine isetionate drops 0.1%/ointment 0.15% (Brolene®) for acanthamoeba keratitis
For hospital use only: azithromycin drops 1.5% (DCH restricted use), cefuroxime drops 5%, *gentamicin 1.5%, ciprofloxacin drops 0.3%
11.3.2 Antifungals
Many different fungi are capable of producing ocular infection. They may be identified by appropriate laboratory procedures. They are not commercially available - contact hospital pharmacy for information
*amphotericin 0.15%, *clotrimazole 1%, *miconazole 1%, *econazole 1%, *natamycin 5%
11.3.3. Antivirals
First line: aciclovir eye ointment 3%, ganciclovir eye gel 0.15% - consultant only, in patients intolerant of aciclovir
11.4 Corticosteroids and other anti-inflammatory preparations
11.4.1 Corticosteroids
For specialist initiation: betamethasone drops/ointment 0.1%, betamethasone 0.1% + neomycin 0.5% drops (Betnesol-N®), dexamethasone drops 0.1% (Maxidex®), *Minims dexamethasone 0.1%, dexamethasone drops/ointment 0.1% + neomycin 0.35% + polymyxin B sulfate 6000 units/ml/g (Maxitrol®), fluorometholone drops 0.1% (FML®), polyvinyl alcohol drops 1.4%, prednisolone drops 0.5% (Predsol®), prednisiolone drops 1% (Pred Forte®), *Minims prednisolone 0.5%, *prednisolone 0.1%, framycetin 0.5% + dexamethasone 0.05% + gramicidin 0.005% drops (Sofradex®)
For hospital use only: loteprednol drops 0.5% (not at DCH), dexamethasone intravitreal implant
11.4.2 Other anti-inflammatory preparations
First line: antazoline 0.5% + xylometazoline 0.05% drops, sodium cromoglicate drops 2%
Second line: lodoxamide drops 0.1% (not at DCH), olopatadine drops 1mg/ml
For seasonal allergies:
Short term allergies first line: antazoline 0.5% + xylometazoline 0.05% drops
Long term allergies first line: sodium cromoglicate
For children: consider olopatadine drops 1mg/ml which is an antihistamine and mast cell stabiliser combined and has advantage of twice daily application
Second line: lodoxomide, olopatadine
11.5 Mydriatics and cycloplegics
Antimuscarinics
For specialist initiation: atropine sulfate drops 1%, *Minims® atropine sulfate 1%, cyclopentolate hydrochloride drops 0.5% and 1%, *Minims cyclopentolate hydrochloride 1%, *Minims® tropicamide 0.5% and 1%
Sympathomimetics
For hospital use only: *Minims phenylephrine hydrochloride 2.5% and 10%
11.6 Treatment of glaucoma
Beta-blockers
Betaxolol drops 0.25% and 0.5% (Betoptic®), levobunolol drops 0.5% (with PVA 1.4% - Liquifilm®) - (Betagan®), timolol drops 0.25% and 0.5%, gel forming solution 0.25% and 0.5% (Timoptol®-LA) ,carteolol drops 1% and 2% (Teoptic®)
Prostaglandin analogues and prostamides
Bimatoprost eye drops 300mcg/ml (Lumigan®), latanoprost eye drops 0.005%, travaprost eye drops 40mcg/ml (Travatan®)
For specialist initiation: *Tafluprost unit dose eye drops 15mcg/ml (Saflutan®)
Prostaglandin analogues and prostamides in combination with timolol
Latanoprost eye drops 0.005% + timolol 0.5% (Xalacom®), travoprost eye drops 40mcg/ml + timolol 0.5% (DuoTrav®)
For specialist initiation: Bimatoprost eye drops 300mcg/ml + timolol 0.5% (Ganfort®)
Sympathomimetics
Brimonidone eye drops 0.2%
Carbonic anhydrase inhibitors and systemic drugs
For specialist initiation: acetazolamide tabs 250mg (Diamox®), acetazolamide m/r caps 250mg (Diamox® SR), acetazolamide inj 500mg, brinzolamide drops 10mg/ml (Azopt®), dorzolamide drops 2% (Trusopt®), *dorzolamide unpreserved unit dose 2% (Trusopt® unpreserved),
Carbonic anhdrase inhibitors amd systemic drugs in combination with timolol
For specialist initiation: brinzolamide drops 10mg + timolol 5mg/ml (Azarga®) - consultant ophthalmologist only, dorzolamide 2% + timolol 0.5% drops (Cosopt®), *dorzolamide 2% + timolol 5% unpreserved unit dose (Cosopt® unpreserved)
Miotics
First line: pilocarpine
11.7 Local anaesthetics
First line: *lidocaine 4% + fluorescein 0.25% Minims®, *oxybuprocaine 0.4% Minims®, *tetracaine 0.5% and 1% Minims®, *proxymetacaine 0.5% Minims®, *proxymetacaine 0.5% + fluorescein 0.25% Minims®
11.8 Miscellaneous ophthalmic preparations
11.8.1 Tear deficiency, ocular lubricants and astringents
First line: hypromellose drops 0.3%, polyvinyl alcohol drops 1.4%, hypromellose 0.3% + dextran'70' 0.1% drops (Tears Naturale®)
Second line: Carbomers eye drops, *hydroxyethycellulose 0.44% + sodium chloride 0.35% Minims®, liquid paraffin ointment, simple eye ointment, *carmellose drops 1%, sodium hyaluronate (as *Hylo-Tear® 0.1% and *Hylo-Forte® 0.2%, which have a novel drop delivery system meaning they have a six month expiry once opened) *Oxyal 0.15%
For specialist initiation: acetylcysteine 5% + hypromellose 0.35% drops (Ilube®), *sodium chloride drops 0.9% Minims® Saline, sodium chloride ointment 5%
11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment
Ocular diagnostic preparations
*Minims® fluorescein sodium drops 1%
For hospital use only: Indocyanine Green 25mg injection NB: unlicensed - named patient only
Ocular peri-operative drugs
For specialiast initiation: acetylcholine chloride solution (Miochol-E®), apraclonidine drops 0.5%, diclofenac sodium unit dose drops 0.1% (Voltarol® Ophtha), ketorolac trometamol drops 0.5% (Acular®)
For hospital use only: ciclosporin drops 2% NB: unlicensed, *potassium ascorbate drops 10%
For hospital use during surgical procedures: fluorescein sodium injection, sodium hyaluronate syringe, xylometazoline (Otrivine®) paediatric nasal drops
Subfoveal choroidal neovascularisation
Ophthalmology consultant only: ranibizumab
