netFormulary NHS
North East and North Cumbria
ICS Formulary
 Search
 Formulary Chapter 11: Eye - Full Chapter
Notes:

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.

Chapter Links...
 Details...
11.06  Expand sub section  Treatment of glaucoma
11.06  Expand sub section  Beta-blockers
11.06  Expand sub section  Prostaglandin analogues
11.06  Expand sub section  Sympathomimetics
11.06  Expand sub section  Carbonic anhydrase inhibitors and systemic drugs to top
Brinzolamide
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 1% eye drops.
 
Dorzolamide
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 2% eye drops.
  • 2% unit dose eye drops.
 
Brinzolamide 1% with Timolol 0.5%  (Azarga®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Brinzolamide 10mg/ml & brimonidine 2mg/ml (Simbrinza®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Approved as a third line agent as an “add-on” in patients at the very end of medical management.
 
 
Acetazolamide
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • second line carbonic anhydrase inhibitor for glaucoma
 
 
Dorzolomide 2% with Timolol 0.5%
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 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.
 
 
11.06  Expand sub section  Miotics
 ....
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
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. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

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 a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary