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BNSSG Adult Joint Formulary

11.8 Miscellaneous ophthalmic preparations

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Last edited: 23-10-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

A preservative free option (or single unit dose drops) may be prescribed if available for all formulary products listed if clinically necessary, as an alternative option
Please ensure that all prescriptions for eye drops clearly state the number of drops, into which eye(s), and the frequency of administration

11.8.1 Tear deficiency, ocular lubricants and astringents

Please see BNSSG Dry Eye Prescribing Guidelines

Recommended: (TLS Green)

Hypromellose 0.3% or 0.5% eye drops

Liquid paraffin eye ointment

Liquid paraffin with Vitamin A eye ointment

Alternatives: (TLS Blue)

Carbomer 980 gel

Please see December 2023 NPSA alert regarding the potential contamination of some carbomer – containing lubricating eye products with Burkholderia cenocepacia. As a precautionary measure, while further testing is conducted, avoid use of all carbomer-containing lubricating eye products for patients in the following groups:

• Individuals with cystic fibrosis

• Patients being cared for in critical care settings (e.g., adult, paediatric and neonatal ICU)

• Severely immunocompromised

• Patients awaiting lung transplantation.

Carmellose sodium eye drops

Sodium hyaluronate

VisuXL^® Gel (TLS Amber Specialist Recommended)

For aqueous deficiency in moderate to severe dry eyes where other treatments have not been effective
Not to be confused with VisuXL^® drops which are non-formulary

HyloDual^® preservative free eye drops (TLS Red)

For patients with severe evaporative dry eye disease

Thealoz Duo^® preservative free eye drops (TLS Red)

For treatment of moderate to severe dry eye disease where there are signs of inflammation as a short course

Acetylcysteine for Tear Deficiency, Impaired or Abnormal Mucus Production

Acetylcysteine 5% eye drops (TLS Blue)

Acetylcysteine 10% eye drops (unlicensed) (TLS Red)

11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment

Ocular Diagnostic Preparations

Fluorescein 1% and 2% single-use eye drops (TLS Green)

Ocular Perioperative Drugs

Ketorolac 0.5% eye drops (TLS Green)

Used for post operative cystoid macular oedema and external eye disease including episcleritis
Do not prescribe Ketorolac 0.5% eye drops (Acular®) in combination with Maxitrol® for any patient.
Corneal melts reported due to combined use of Ketorolac and Maxitrol® eye preparations.
Be vigilant of any suspected / reported corneal melts associated with topical Maxitrol® and Ketorolac eye drops, refer for specialist advice and report them as an incident on Datix and using the MHRA yellow card.

Diclofenac 0.1% preservative free eye drops (Eye hospital only) (TLS Red)

Alternative:

Apraclonidine 1% eye drops (TLS Blue)

Subfoveal Choroidal Neovascularisation

Aflibercept (TLS Red)

NICE TA294 for treatment of wet age-related macular degeneration
NICE TA305 for the treatment of macular oedema (central retinal vein occlusion)
NICE TA346 for the treatment of diabetic macular oedema
NICE TA409 for treating visual impairment caused by macular oedema after branch retinal vein occlusion
NICE TA486 for treating choroidal neovascularization

Brolucizumab (TLS Red)

NICE TA672 Brolucizumab for treating wet age-related macular degeneration
NICE TA820 Brolucizumab for treating diabetic macular oedema

Faricimab (TLS Red)

NICE TA799 Faricimab for treating diabetic macular oedema
NICE TA800 Faricimab for treating wet age-related macular degeneration
NICE TA1004 Faricimab for treating visual impairment caused by macular oedema after retinal vein occlusion

Ranibizumab (TLS Red)

NICE TA155 for neovascular age-related macular degeneration
NICE TA274 for the treatment of diabetic macular oedema
NICE TA283 macular oedema secondary to retinal vein occlusion
NICE TA298 choroidal neovascularisation associated with pathological myopia
For treatment of choroidal neovascularisation associated with angioid streaks and retinal dystrophies (unlicensed)

Verteporfin (TLS Red)

For photodynamic treatment of age-related macular degeneration associated with predominantly classic subfoveal choroidal neovascularisation or with pathological myopia

Retinal Vein Occlusion

Bevacizumab (TLS Red)

For treatment of neovascular glaucoma due to ischaemic central retinal vein occlusion (unlicensed)
For the treatment of non-ischaemic central retinal vein occlusion
For the treatment of choroidal neovascularisation associated with angioid streaks and retinal dystrophies
For radiation maculopathy
For neovascular glaucoma
For corneal neovascularisation
For pre-treatment option for vitrectomy

11.8.3 Other Miscellaneous eye preparations

Immunosuppressants

Ciclosporin 0.2% eye ointment (unlicensed) (TLS Red)

Ciclosporin 1mg/mL eye drops (Ikervis) (TLS amber 3 months)

NICE TA369 For treating dry eye disease that has not improved despite treatment with artificial tears (Click here for shared care protocol)

Tacrolimus 0.03%, 0.1% ointment (unlicensed) (TLS Red)

Immunomodulating

Interferon alfa-2a 1 million units in 1mL eye drops (unlicensed) (TLS Red)

Interferon alfa-2b 1 million units in 1mL eye drops (unlicensed) (TLS Red)

Cytotoxic

Mitomycin 0.02% and 0.04% eye drops (unlicensed) (TLS Red)

Others

Potassium ascorbate 10% eye drops (unlicensed) (TLS Red)

Cacicol^® (TLS Red)

For corneal specialist only

Mercaptamine (eye drops) (TLS Red)

For corneal cystine deposits in children over 2 years old and adults as per NHS England Specialised Commissioning Policy

Non-infectious Uveitis

Adalimumab (TLS Red)

NICE TA460 Adalimumab and dexamethasone (Ozurdex^®) for treating non-infectious uveitis
Specify brand when prescribing Imraldi^®, Hyrimoz^®, Amgevita^®, Humira^®

Adult Severe Refractory Uveitis

NHS England Clinical Commissioning Policy:Infliximab (Remicade^®) and Adalimumab (Humira^®) as Anti-TNF Treatment Options for Adult Patients with Severe Refractory Uveitis

NHSE Policy Statement - Adalimumab for Severe Refractory Uveitis

Other

Botulinum toxin type A (TLS Red)

For ptosis in non-healing epithelial defects as an alternative to suture tasorrhaphy

See Botulinum Toxin Pathway page for more information

Insulin eye drops (TLS Red)

For short term use for patients with corneal persistent epithelial defects that are refractory to usual treatment in clinical practice to promote epithelisation, under the advice of a corneal specialist at Bristol Eye Hospital.

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