Tear deficiency, ocular lubricants, and astringents
Use products in line with Leicestershire Guide to Prescribing Ocular Lubricants Please see individual product entries for detail on preservative contained. (BZCL is benzalkonium chloride, which may cause ocular irritation; purite is a biodegradable low allergenic preservative system). Preservative free drops are only indicated if:-
There is known toxicity or allergy to preservatives.
Drops are required 4 times a day or more in the presence of tear deficiency or epithelial instability.
Liquid paraffin plus Vitamin A eye ointment (VitA-POS®)
Xailin Night® eye ointment
Contains white soft paraffin, white mineral oil and lanolin alcohols. (Preservative free).
Carmellose 0.5% plus sodium hyaluronate 0.1% (Optive Fusion®)
Sodium Chloride 0.9%
Single use eye drops. Sterile solution for irrigation.
These preparations are commonly used to remove irritants and foreign bodies from the eye. They are also useful as irrigation where eyelid disease prevents secretion by meibomian glands. A new (sealed) pack of irrigation solution should be used for each patient to prevent cross-contamination. Any contents remaining after use should be discarded.
(contains polyquaternium-1) For treatment of meibomian gland disease
Acetylcysteine 10% (unlicensed)
Sodium chloride 5% (unlicensed)
Drops and ointment available
Ciclosporin ophthalmic emulsion (Ikervis®)
Specialist ophthalmologist initiation for use in line with NICE TA 369 only for treating severe keratitis in adult patients with dry eye disease that has not improved despite treatment with tear substitutes. Prescribe by brand.
Date of entry of decision to Formulary: March 2016
Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety.
All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry
Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).
Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.
Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.
Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.
Drugs not yet reviewed
Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence. See comments under individual entries