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 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.

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11.08.02  Expand sub section  Ocular diagnostic and peri-operative preparations and photodynamic treatment
11.08.02  Expand sub section  Ocular diagnostic preparations
Fluorescein
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Formulary
Red
  • 2% minims eye drops
  • 1mg ophthalmic strips
  • Fluorets
  • 10% 5ml & 20% 5ml injections unlicensedunlicensed
 
 
Lissamine Green
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Formulary
Red
1.5mg ophthalmic strips 
 
Indocyanine green
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Unlicensed Drug Unlicensed
Red

25mg injection.

 
 
11.08.02  Expand sub section  Ocular peri-operative drugs
Diclofenac
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Formulary
Red
  • 0.1% eye drops and unit dose eye drops.
  • For post-operative inflammation limited to patients where corticosteroids are unsuitable.
 
 
Acetylcholine Chloride
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Formulary
Red
  • 20mg in 2ml injection.
 
 
Apraclonidine
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Formulary
Green plus
  • 0.5% and 1% ophthalmic solution.
 
 
Ketorolac (Acular®)
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Formulary
Red
  • 0.5% eye drops.
 
 
Nepafenac
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Formulary
Red
  • 1 mg/1mL eye drops
 
 
Povidone iodine 5% eye drops
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Formulary
Red
  • For use in eye surgery only. 
 
 
Sodium Hyaluronate
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Formulary
Red
  • 10mg in 1ml bag (Z-Hyalin®, formerly Ophthalin Gelbag®)
  • 14mg in 1ml syringe (Healon GV®)
 
 
Duovisc® Injection
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Unlicensed Drug Unlicensed
Red
  • Injection for use in cataract surgery containing VisCoat (1% sodium hyaluronate) and ProVisc (3% sodium hyaluronate, 4% chondroitin sulphate).
 
 
Ethanol 20% eye drops.
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Unlicensed Drug Unlicensed
Red
  • For use in the debridement of the corneal epithelium in patients with
    recurrent corneal erosion syndrome.
 
 
11.08.02  Expand sub section  Subfoveal choroidal neovascularisation
Aflibercept 4mg/0.1ml injection (Eylea®)
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Formulary
Red
High Cost Medicine
CCG
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for macular oedema – central retinal vein occlusion in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE.
  • Approved as an option for treating visual impairment because of myopic choroidal neovascularisation in adults in line with NICE

 

 
Link  NICE TA 294 Aflibercept solution for injection for treating wet age‑related macular degeneration
Link  NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA 346 Aflibercept for treating diabetic macular oedema
Link  NICE TA 409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
Link  NICE TA 486: Aflibercept for treating choroidal neovascularisation
 
Brolucizumab (Beovu®)
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Formulary
Red
High Cost Medicine
CCG
  • 19.8mg/0.165mL solution for injection (pre-filled syringes)
    • Approved for treating wet age-related macular degeneration in adults in line with NICE
 
Link  MHRA Drug Safety Update (Jan 2022): Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
Link  NICE TA672: Brolucizumab for treating wet age-related macular degeneration
Link  NICE TA820: Brolucizumab for treating diabetic macular oedema
 
Faricimab (Vabysmo® )
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Formulary
Red
CCG
  • 120mg/1ml solution for injection
    • Approved for the treatment of diabetic macular oedema in adults in line with NICE
    • Approved for the treatment of wet age-related macular degeneration in line with NICE
 
Link  NICE TA799: Faricimab for treating diabetic macular oedema
Link  NICE TA800: Faricimab for treating wet age-related macular degeneration
 
Ranibizumab 10mg/1ml injection (Lucentis®)
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Formulary
Red
High Cost Medicine
CCG
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for visual impairment caused by macular oedema secondary
    to retinal vein occlusion in line with NICE.
  • Approved as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia in line with NICE.

 

 

 
Link  NICE TA 274 Ranibizumab for treating diabetic macular oedema
Link  NICE TA 155 Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA 283 Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA 298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
 
Verteporfin 15mg Injection (Visudyne®)
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Formulary
Red

Approved for photodynamic therapy in wet age-related macular degeneration in line NICE.

 
Link  NICE NG82: Age-related macular degeneration
Link  NTAG Decision Summary June 2020: Verteporfin
 
Bevacizumab 1.25mg/0.5ml intravitreal injection
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Unlicensed Drug Unlicensed
Red
CCG
  • NETAG approved for use in the management of macular oedema
    secondary to retinal vein occlusion. This is considered a more cost
    effective treatment option in RVO compared with ranibizumab.
  • NTAG approved for age related macular degeneration.

 

 
 
11.08.02  Expand sub section  Vitreomacular traction to top
Ocriplasmin (Jetrea®)
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Formulary
Red
High Cost Medicine
  • Approved for use in patients with vitreomacular traction who also have no epiretinal membrane and a hole (up to 400 micrometres) in the centre of their retina or severe sight problems in line with NICE.
 
Link  NICE TA 297 Ocriplasmin for treating vitreomacular traction
 
11.08.02.04  Expand sub section  Other products - Mainly for treating ocular injuries
11.08.02.04  Expand sub section  Antifungals
11.08.02.04  Expand sub section  Cytotoxics / wound healing modulators
11.08.02.04  Expand sub section  Fibrinolytic drugs
11.08.02.04  Expand sub section  Glues - ocular to top
11.08.02.04  Expand sub section  Immunosuppressants
11.08.02.04  Expand sub section  Treatment of burns
Holoclar®
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Formulary
Red
High Cost Medicine
  • Approved for treating limbal stem cell deficiency after eye burns in line with NICE and NHS England Commissioning Policy as of 14 November 2017
 
 
11.08.02.04  Expand sub section  Visco-elastics
11.08.02.04  Expand sub section  Other
Alteplase intravitreal injection
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Formulary
Red
 
 
Mydrane
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Formulary
Red

Intracameral injection: tropicamide 0.2 mg/mL, phenylephrine 3.1 mg/mL, lidocaine 10 mg/mL; 0.6 mL ampoules

 
 
Ascorbic acid 10% Preservative-free eye drops
(Potassium ascorbate)
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Unlicensed Drug Unlicensed
Red
 
 
Disodium edetate 0.37% solution
(20ml)
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Unlicensed Drug Unlicensed
Red
 
 
Sodium Citrate 10.11% eye drops
(equivalent to citrate 6.5%)
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Unlicensed Drug Unlicensed
Red
 
 
Tretinoin 0.05% eye drops
(Retinoic acid)
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Unlicensed Drug Unlicensed
Red
 
 
 ....
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.  

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