NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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11 Eye

11.8 Miscellaneous ophthalmic preparations

11.8.1 Tear deficiency, ocular lubricants, and astringents

Patients with chronic dry eye conditions should be educated that long-term and regular use of eye lubricants is recommended to achieve maximum benefit. Many of the preparations for dry eyes are considered to be medical devices rather than medicines. The preparations listed in this section are all included in Part 3 of the Scottish Drug Tariff (Appliances) and are able to be prescribed on a GP10 prescription.

Preferred list
CLINITAS GEL (EYE DROPS)

Prescribing Notes:

Clinitas gel is considered the first line treatment for dry eye conditions. Contains carbomer 980 0.2% as the active ingredient with cetrimide being the preservative.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/213751.htm#_213751

HYPROMELLOSE (eye drops)

Restrictions: excludes single dose unit preparations.

Prescribing Notes:

Excipients may include benzalkonium chloride

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5543.htm

LACRI-LUBE (Eye ointment)

Prescribing Notes:

Contains liquid paraffin as the active ingredient

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5551.htm#_5551

VISCOTEARS (eye drops)

Restrictions: Restrictions: Excludes the unit dose vial presentation

Prescribing Notes:

Contains carbomer 980 0.2% as the active ingredient with cetrimide being the preservative

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/23395.htm

VITA-POS (eye ointment)

Prescribing Notes:

Contains liquid paraffin as the active ingredient

Total Formulary
BLINK INTENSIVE TEARS (Eye drops)

Restrictions: Restricted to use in severe dry eyes only

Prescribing Notes:

Considered the first line sodium hyaluronate preparation

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/200834.htm

CELLUVISC (eye drops)

Restrictions: Restricted to use in severe dry eyes only.

Prescribing Notes:

Carmellose sodium available as single dose units in strengths of 0.5% or 1%

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106171.htm#_106171

CICLOSPORIN (IKERVIS) (eye drops)

Restrictions: Restricted to initiation by consultant ophthalmologists for the treatment of severe keratitis in adults with dry eye disease which has not improved despite treatment with tear substitutes.

HYLO-FORTE (eye drops)

Restrictions: Restricted to use in severe dry eye only. This preparation should only be considered for patients with dexterity problems and for whom this administration system is suitable.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP7125-hylo-forte.htm#PHP7125-hylo-forte

ILUBE (Eye drops)

Restrictions: Restricted to use in severe dry eye only

Prescribing Notes:

Contains acetylcysteine 5% and hypromellose 0.35%.

Excipients include benzalkonium chloride and disodium edetate

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5540.htm

OPTIVE FUSION (eye drops)

Restrictions: Restricted to use in severe dry eye only

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34575-optive-fusion.htm?q=optive&t=search&ss=text&p=2#PHP34575-optive-fusion

OPTIVE PLUS (eye drops)

Restrictions: Restricted to use in severe dry eye only

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34571-optive-plus.htm?q=optive%20plus&t=search&ss=text&p=1#PHP34571-optive-plus

OXYAL (eye drops)

Restrictions: Restricted to use in severe dry eye only

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP7127-oxyal.htm?q=oxyal&t=search&ss=text&p=1#PHP7127-oxyal

SYSTANE BALANCE (EYE DROPS)

Restrictions: Restricted to use in severe dry eye only

11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment

Total Formulary
Sodium hyaluronate (Intra-ocular injection)
FLURBIPROFEN

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5566.htm

KETOROLAC

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/39803.htm

MIOCHOL

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106242.htm

VERTEPORFIN

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/90014.htm

AFLIBERCEPT (EYLEA) (intravitreal injection)

Restrictions: Restricted to specialist use for indications detailed under Prescribing Notes.

Prescribing Notes:

Formulary indications are:

  • Use in adults for the treatment of neovascular (wet) age-related macular degeneration. 
  • Treatment of visual impairment due to macular oedema secondary to central retinal vein occlusion in accordance with NHSGGC protocol. 
  • Treatment of visual impairment due to macular oedema secondary to branch retinal vein occlusion (protocol in development)
  • Treatment of visual impairment due to diabetic macular oedema (DMO) in adults.  It is restricted to specialist use for the treatment of visual impairment due to DMO in adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline. 
  • Treatment of visual impairment due to myopic choroidal neovascularisation (myopic CNV) in line with national guidance.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP19018-aflibercept.htm?q=aflibercept&t=search&ss=text&p=1#_hit

APRACLONIDINE (eye drops)

Restrictions: Restricted to specialist initiation for the diagnosis of Hornor’s syndrome and post-laser surgery.

Prescribing Notes:

For use in the management of glaucoma, see section 11.6.7

NEPAFENAC (1mg/ ml eye drops)

Restrictions:

the reduction of postoperative macular oedema associated with cataract surgery in diabetic patients is restricted to specialist initiation in diabetic patients with retinopathy.

Prescribing Notes:

Initial supply should be obtained from the specialist centre with GP prescribing only necessary where the specialist considers extending the course of treatment to a total duration of 60 days.

For the relevant SMC advice click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP7163-nevanac.htm#PHP7163-nevanac

NEPAFENAC (3mg/ml eye drops)

Restrictions:

Restricted to specialist use for reduction in the risk of postoperative macular oedema associated with cataract surgery in diabetic patients.

Prescribing Notes:

Nepafenac 3mg/mL eye drops provide a once daily alternative to nepafenac 1mg/mL eye drops (administered three times daily). 

The use of nepafenac 3mg/ml eye drops is not recommended by SMC for use for postoperative pain and inflammation associated with cataract surgery and remains non-formulary.

OCRIPLASMIN (JETREA) (intravitreal injection)

Restrictions: Restricted to use only by Vitreo-retinal Surgeons in patients who are unfit for surgery who have either vitreomacular traction plus macular hole, regardless of whether they have epiretinal membrane formation, or vitreomacular traction alone (no epiretinal membrane and no macular hole).

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP33811-ocriplasmin.htm?q=ocriplasmin&t=search&ss=text&p=1#_hit

RANIBIZUMAB (intravitreal injection)

Restrictions: Ranibizumab is restricted to specialist use in accordance with local protocols for the different formulary indications as listed in the prescribing notes section.

Prescribing Notes:

Formulary indications (in accordance with local protocols):

  • The treatment of neovascular (wet) age-related macular degeneration (AMD)
  • The treatment of visual impairment due to diabetic macular oedema (DME)
  • The treatment of visual impairment due to macular oedema secondary to retinal vein occlusion (branch RVO or central RVO)
  • The treatment for visual impairment due to choroidal neovascularisation secondary to pathologic myopia

NHSGGC Protocols for the Formulary inidcations can be accessed here (NHS network access required)

 

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/130047.htm