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BNSSG Paediatric Joint Formulary

11.8 Miscellaneous ophthalmic preparation

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Last edited: 31-01-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

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

Hypromellose 0.3% or 0.5% eye drops (TLS Green)

Liquid paraffin eye ointment (TLS Red)

Alternatives:

Carbomer 980 gel (TLS Blue)

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 0.5% or 1% eye drops (TLS Blue)

Sodium chloride 5% drops (TLS Red)

Specific indication:

Sodium hyaluronate (0.2%) (TLS Blue)

For Refractory Surgery protocol, dry eyes and in the corneal service for patients with severe external eye disease

Acetylcysteine for Tear Deficiency

Acetylcysteine 5% / Hypromellose 0.35% (Ilube^®) 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% or 2% single-use eye drops (TLS Green)

Fluorescein IV (TLS Red)

For imaging of retinal vasculature for diagnosis of retinopathy of prematurity.

Ocular Perioperative Drugs

Ketorolac 0.5% eye drops (TLS Red)

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)

Apraclonidine 1% eye drops (TLS Red)

Subfoveal Choroidal Neovascularisation

Aflibercept (TLS Red)

NICE TA294 for treatment of wet aged-related macular degeneration
NICE TA305 for the treatment of macular oedema (central retinal vein occlusion)
NICE TA346 for the treatment of diabetic macular oedema

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 dystophies as per criteria based access policy (unlicensed)
NHSE SSC 2523 For the treatment of retinopathy of prematurity disease in preterm babies

Retinal Vein Occlusion

Bevacizumab (TLS Red)

For treatment of neovascular glaucoma due to ischaemic central retinal vein occlusion as per criteria based access policy (unlicensed)

Other Miscellaneous Eye Preparations

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

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

Cytotoxic

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

Others

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

Mercaptamine (eye drops) (TLS Red)

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

Immunosuppressants

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

Ciclosporin 1mg/mL eye drops (TLS Red)

NICE TA369 Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears

Ciclosporin 1mg/mL eye drops (Verkazia^®) (TLS Amber Specialist Recommended)

For treating severe vernal keratoconjunctivitis in children from 4 years old