BNF CHAPTER 11: EYE 1 January 2018

Transcription

1 BNF CHAPTER 11: EYE 1

2 BNF ANTIBACTERIALS First Choice. Broad spectrum. Chloramphenicol 0.5% Eye Drops Administration Alternative Administration Eye drops, apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing; Chloramphenicol 1% Eye ointment. Eye ointment, apply either at night (if eye drops used during the day) or 3 4 times daily (if eye ointment used alone). See position statement for Prescribing of Medicines that are Available for Purchase for Self-Care ; also see OTC supporting information BNF ANTIVIRALS Aciclovir 3% Eye Ointment 2

3 BNF CORTICOSTEROIDS First Choice Betamethasone 0.1% Eye Drops Betamethasone 0.1% Eye ointment Alternative Dexamethasone 0.1% Eye Drops Topical Corticosteroids should normally be used under expert supervision. BNF OTHER ANTI-INFLAMMATORY PREPARATIONS First Choice Sodium Cromoglicate 2% Eye Drops Alternative Nedocromil sodium 2% Eye Drops Cromoglicate preparations should be prescribed generically, as branded versions are considerably more expensive. See position statement for Prescribing of Medicines that are Available for Purchase for Self-Care and OTC supporting information 3

4 BNF 11.6 TREATMENT OF GLAUCOMA Treatment of glaucoma should be under the supervision of the hospital or specialist. New NICE CG 81. November BETA-BLOCKERS: s Timolol maleate Eye Drops / Levobunolol hydrochloride Eye Drops / Betaxolol hydrochloride solution Eye Drops Single unit dose Choice Timolol maleate single dose Eye Drops PROSTAGLANDIN ANALOGUES AND PROSTAMIDES Latanoprost Eye Drops Single unit dose Choice Latanoprost (Monopost ) 4

5 PROSTAGLANDIN ANALOGUES with BETA-BLOCKERS Latanoprost with timolol Eye Drops generic Single unit dose Choice Latanoprost single unit dose (Monopost ) + Timolol single unit dose (Tiopex ) Alternative Bimatoprost with timolol Eye Drops (Ganfort Preservative Free) SYMPATHOMIMETICS Brimonidine Eye Drops With Timolol, please prescribe both items generically separately. With CARBONIC ANHYDRASE INHIBITORS (Dorzolamide), please prescribe items generically separately 5

6 CARBONIC ANHYDRASE INHIBITORS AND SYSTEMIC DRUGS Dorzolamide Eye Drops With Timolol Dorzolamide+Timolol generic Eye Drops With Timolol Single unit dose Dorzolamide+Timolol (Cosopt unit dose) If oral treatment is needed, Acetazolamide 250 tablelts are more cost effective than sustain release capsules at the time of developing this chapter (). MIOTICS Pilocarpine Eye Drops 6

7 BNF TEAR DEFICIENCY, OCULAR LUBRICANTS, AND ASTRINGENTS Component 10ml bottle / 10gr tube Eye Drops - Hypromellose Generic 0.3%-0.5%-1% Eye Gel - Carbomer Eye Drops - Carmellose Eye Drops - Sodium Hyaluronate Eye Ointment - Paraffin Based Clinitas Carbomer gel Lumecare Carbomer 0.2% gel Blink Intensive Tears 0.25% Vizulize 0.1% eye drops - 3 month expiry after opening 10ml bottle Preservative Free / 5gr tube Preservative Free Evolve Hypromellose 0.3% (formerly Lumecare Evolve Hypromellose 0.3%) Evolve Carmellose 0.5% (formerly Lumecare Evolve Carmellose 0.5%) HydraMed 0.2% Hylo-Forte 0.2% Initiation in Secondary Care only HydraMed Night Xailin Night Comments If PF hypromellose is needed (used more than 4 times a day), patient needs to be reviewed and a different agent prescribed. Hylo-range 6 month expiry. 300 drops per container. Prescribe 1 bottle every two months. For night use only These products are used 3-4 times a day or as required. Please note it is ONLY more cost-effective to start with a preparation with a 6 month expiry if patient uses it less than four times a day. Optive Plus 0.5% / Systane Balance are reserved for lipid replacement in Meibomian Gland Dysfuction (MGD). Iniciation in Secondary Care only Sodium Chloride 0.5% should be prescribed only in the hospital for 2-3 months until cornea transplant occurs. Ciclosporin eye drops should be started in Secondary Care for treating severe keratitis in adult patients where immunomodulatory effect is needed, with dry eye disease that has not improved despite treatment with tear substitutes. For more information, refer to CCG Dry Eye Guidelines 7

8 BNF OCULAR PERI-OPERATIVE DRUGS s Ketorolac Eye Drops - Acular Preservative free Choice Diclofenac single dose units - Voltarol Ophtha Apraclonidine (Iopidine ) is a RED traffic light drug; it should be prescribed by specialist. It is used to control increases in intra-ocular pressure associated with ocular surgery and as short-term treatment to reduce intra-ocular pressure prior to surgery. Also as short-term adjunctive treatment of chronic glaucoma in patients not adequately controlled by another drug for max. 1 month. Formulary Chapter 11 EYE Date ratified by D&T Committee April st Amendment May 2016 Ratified by D&T May nd Amendment Update TEAR DEFICIENCY, OCULAR LUBRICANTS, AND ASTRINGENTS Review Rest of formulary Ratified by D&T February 2018 Next Review Date February