North East and North Cumbria
ICS Formulary
 
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11 Eye

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.

11-06 Carbonic anhydrase inhibitors and systemic drugs

Brinzolamide
First Choice
  • 1% eye drops.

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Dorzolamide
First Choice
  • 2% eye drops.
  • 2% unit dose eye drops.

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Brinzolamide 1% with Timolol 0.5%  Azarga®
Formulary

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Brinzolamide 10mg/ml & brimonidine 2mg/ml Simbrinza®
Formulary
  • Approved as a third line agent as an “add-on” in patients at the very end of medical management.

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Acetazolamide
Formulary
  • second line carbonic anhydrase inhibitor for glaucoma

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Dorzolomide 2% with Timolol 0.5%
Formulary
  • 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.

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