netFormulary

North East and North Cumbria
ICS Formulary

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.

11-04-01 Corticosteroids

Betamethasone 0.1% eye drops

First Choice

Dexamethasone 0.05%, framycetin sulf. 0.5%, gramicidin 0.005% eye drops Sofradex

Formulary

Hydrocortisone Sodium Phosphate Softacort^®

Formulary

3.35 mg per 1 ml eye drops (0.4ml unit dose)
- Approved for patients who require a preservative-free low potency ocular corticosteroid

Rimexolone

Formulary

ophthalmology advice only - second line if flurometholone unsuitable

Betamethasone 0.1% with Neomycin 0.5% eye drops

Formulary

Dexamethasone 0.1% eye drops Maxidex^®

Formulary

Preservative-free eye drops are also approved.
- 0.1% Minims® - first choice.
- 0.1% preservative free eye drops unlicensed - approved only for patients who are unable to use Minims®due to dexterity problems.

Dexamethasone 0.1% Preservative-free

Formulary

First choice

Unit dose vials (Minims®)

Alternative

Eye drops (unlicensed) - only for patients who are unable to use Minims® due to dexterity problems

Dexamethasone with Neomycin and Polymyxin B sulphate Maxitrol^®

Formulary

Eye drops and eye ointment

Fluorometholone 0.1% Eye drops FML^®

Formulary

For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist.

Loteprednol Eye drops

Formulary

Approved as a second line agent to conventional corticosteroid eye drops, treatment to be imitated with the advice of an ophthalmologist only.

Prednisolone 0.5% Single Use Minims^®

Formulary

Prednisolone eye drops

Formulary

The following formulations are approved
- 0.5% eye drops and 1% (Pred-Forte).
- 0.1% and 0.3% eye drops - both unlicensed.
Approved preservative free formulations include
- 0.5% minims.
- 0.1%, 0.3%, 0.5% and 1% - all unlicensed.

Dexamethasone 700 microgram intravitreal implant Ozurdex^®

Formulary

Approved for macular oedema following central retinal vein occlusion
in line with NICE.
Approved for treating diabetic macular oedema in line with NICE.
Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy

Note: The Northern (NHS) Treatment Advisory Group recommends the sequential pharmacological management of MO secondary to RVO as per the North East Retina Group (NERG) RVO treatment pathway.

NICE TA229 Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion

NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis

NICE TA824: Dexamethasone intravitreal implant for treating diabetic macular oedema

Fluocinolone 190 microgram intravitreal implant

Formulary

Recommended as a possible treatment for people with chronic diabetic macular oedema who have an artificial lens in their eye if the implant is used in the eye with the artificial lens and their diabetic macular oedema has not got better with other treatments - in line with NICE.
Approved for the treatment of recurrent non-infectious uveitis in line with NICE
Approved for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy in line with NICE
Approved for treating chronic diabetic macular oedema in line with NICE

NICE TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy

NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis

NICE TA613: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy

NICE TA953: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema

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