11.1 ADMINISTRATION OF EYE DROPS AND EYE OINTMENTS

[Pages:13]11.1 ADMINISTRATION OF EYE DROPS AND EYE OINTMENTS

Drops Gently pull down the lower eyelid to form a pocket and instil ONE drop. Keep the eye closed for as long as possible after instillation. There is no indication for administering more than one drop. When 2 or more different types of eye drops need to be administered at the same time of day leave an interval of at least 5 minutes between instillation of each different preparation. This prevents dilution and overflow which can occur if one drop is administered immediately after another.

Ointment Gently pull down the lower eyelid to form a pocket and apply a small amount of ointment into the pocket; blinking helps to spread the ointment over the eye.

Compliance aids

Eye-drop dispenser devices are available to facilitate the administration of eye-drops from bottles. These may be useful in the elderly, visually impaired or those with physical limitations such as arthritis or Parkinson's disease.

Preservative-free preparations

Preservatives and sensitisers are used in eye preparations. Details of such agents can be found under individual product entries in the BNF. Preservative free single use products (eg Minims) are available. These preparations are generally more expensive and therefore their use must be carefully considered and only used in patients with a known hypersensitivity to preservatives or in patients who must continue to wear contact lenses. Some preservative free preparations are also available from specialist NHS manufacturing units; contact pharmacy for availability.

Prescribing for Contact Lenses users

Special care is required in prescribing eye preparations for contact lens users. Some drugs and preservatives present in eye preparations can accumulate in hydrogel lenses and may induce toxic reactions. Unless medically indicated, lenses should be removed before treatment commences and should not be worn for the duration of the treatment. Preservative-free eye drops may be used. Eye ointments and oily eye drops should never be used in conjunction with contact lens wear.

11.3 ANTI-INFECTIVE EYE PREPARATIONS

11.3.1 ANTIBACTERIALS

Topical chloramphenicol may be used as a first line option for the routine management of suspected bacterial infection that does not require the initial attention of a Consultant Ophthalmologist. Improvement should begin to be seen in 24-48 hours; if not review treatment and consider changing antibiotic or in serious cases, specialist referral. Treatment should continue for 24 hours after the infection has cleared.

Chloramphenicol

0.5% eye drops

1% eye ointment

0.5% Minims eye drops (only if known allergy to preservatives)

In Secondary Care the antibiotics below would normally only be initiated by the Ophthalmology Team.

Fusidic acid (Fucithalmic?)

1% MR eye drops in gel basis

Gentamicin

0.3% eye drops (suitable for primary care prescribing)

Gentamicin preparations below for hospital use only.

0.3% Minims eye drops

1.5% strong eye drops (special - Moorfields)

Ofloxacin

0.3% eye drops

Ofloxacin should be considered as the quinolone of choice as it is half the price of ciprofloxacin eye drops with a similar spectrum

The following antibiotic eye drops are for hospital use only

Levofloxacin

0.5% eye drops 5mL 0.5% single use units

Benzylpenicillin Cefuroxime Teicoplanin

20,000units per ml eye drops

made by our Sterile and Aseptic Services Unit upon ophthalmology request

5% eye drops

made by our Sterile and Aseptic Services Unit upon ophthalmology request

2% eye drops

made by our Sterile and Aseptic Services Unit upon ophthalmology request

Other anti-infective preparations for hospital use only

Povidone iodine

5% preservative free eye drops For use in laser clinic

Chlorhexidine digluconate 0.02% preservative free eye drops For use in laser clinic if iodine allergic

May also be used for the treatment of acanthamoeba keratitis

Propamidine isetionate (Brolene?)

0.1% eye drops 0.15% eye ointment (dipbromopropamidine isetionate)

For the treatment of acanthamoeba keratitis only

11.3.3 ANTIVIRALS

Aciclovir

3% eye ointment

Aciclovir may be initiated by GPs for patients with known recurrent herpetic ulceration which has been initially diagnosed by an Ophthalmologist

 Ganciclovir

0.15% eye drops

For aciclovir-resistant Herpes Simplex infections

Trifluridine (F3T)

1% eye drops (special ? Stockport)

11.4 CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS

11.4.1 CORTICOSTEROIDS

Betamethasone

0.1% eye, ear, nose drops 0.1% eye ointment

Dexamethasone

0.1% eye drops

0.1% preservative free eye drops (special ? Moorfields) (reserved for patients with a known allergy to

benzalkonium chloride)

Fluorometholone (FML?)

0.1% eye drops

Hydrocortisone

0.5% eye ointment 1% eye ointment

Prednisolone sodium phosphate

0.5% eye, ear drops (Predsol) (suitable for primary care)

0.5% Minims eye drops (reserved for patients with a known

allergy to benzalkonium chloride)

Preparations below for hospital use only

0.03% eye drops (special ? Moorfields)

0.03% preservative free eye drops (special ?

Moorfields) (reserved for patients with a known allergy to

benzalkonium chloride)

0.1% eye drops (special ? Moorfields)

0.5% preservative free eye drops (special ? South Devon Healthcare) (reserved for patients with a known

allergy to benzalkonium chloride)

1% preservative free eye drops (special ? South Devon Healthcare) (reserved for patients with a known

allergy to benzalkonium chloride)

Prednisolone acetate Loteprednol

1% eye drops (Pred Forte)

0.5% eye drops Has less effect on intra-ocular pressure. Useful for treating uveitis in steroid responders.

Corticosteroids with antibacterial agent

Tobradex? (dexamethasone 0.1% / tobramycin 0.3%)

eye drops

For post-operative management of intra-ocular surgery eg cataract

Maxitrol? (dexamethasone/ neomycin/ polymyxin)

eye drops, eye ointment

Requires careful monitoring for signs of corneal erosion

Intravitreal corticosteroids

Dexamethasone (Ozurdex?)

700micrograms intravitreal implant

For treatment of macular oedema following central or branch retinal vein occlusion according to NICE TA229

11.4.2 OTHER ANTI-INFLAMMATORY PREPARATIONS

Sodium cromoglicate Olopatadine

2% eye drops 1mg/mL eye drops

11.5 MYDRIATICS AND CYCLOPLEGICS

Antimuscarinics

Atropine sulphate Cyclopentolate Homatropine

1% eye drops 1% Minims? eye drops

0.5%, 1% eye drops 0.5%, 1% Minims? eye drops

1% eye drops

Tropicamide

0.5%, 1% Minims? eye drops

The following are available for Paediatric use only:

Atropine Cyclopentolate Tropicamide

0.5% eye drops 0.5% eye drops 1% eye drops

Sympathomimetics

Phenylephrine

2.5%, 10% Minims? eye drops

With tropicamide

Mydriasert? (phenylephrine HCl 5.4mg/ tropicamide 280micrograms)

Ophthalmic insert For use in for pre-operative mydriasis only

11.6 TREATMENT OF GLAUCOMA

Beta-blockers

Cardioselective

If a patient with asthma or chronic obstructive airways disease is deemed to need treatment with an ophthalmic beta-blocker, a selective beta-blocker is preferred. However, even this agent must be used with EXTREME caution.

Betaxolol Non-selective Timolol

0.5% eye drops

0.25% eye drops ? twice daily administration This preparation should be considered first line 0.25% unit dose eye drops Use only where preservative free preparation required

0.25% Timoptol LA? ? once daily administration Useful if proven compliance issues or where eye drops are usually administered by a carer or district nurse

There is only limited evidence to suggest that the 0.5% timolol eye drops have a significantly greater ability to reduce intra-ocular pressure over the 0.25% eye drops and are therefore not included in this formulary. Patients currently receiving these preparations may continue on them.

Prostaglandin analogues

The preparations below are listed in order of clinical preference

 Latanoprost Travoprost Bimatoprost

50 micrograms/ml eye drops (once daily use in the evening)

40 micrograms/ml eye drops (once daily use in the evening) 300micrograms/ml eye drops (once daily use in the evening)

Preservative free preparation

Tafluprost

Unit dose eye drops (0.3mL)

To be used only in patients who need a prostaglandin but who are known to be allergic to benzalkonium chloride.

If the patients has a reaction to Latanoprost then switch to Timolol if appropriate or to Brinzolamide. If the reaction continues, consider the possibility of allergy to benzalkonium chloride.

In addition to Tafluprost, preservative free topical preparations include unit dose timoptol and dorzolamide, and minims pilocarpine

Combination with beta-blocker

Xalacom ?

(latanoprost 50 micrograms/ timolol 5 mg/ml)

eye drops (once daily use in the morning)

Combination products may be useful if proven compliance issues or administration by district nurse or carer required however, they do not provide the required twice daily dose of beta-blocker. A more appropriate regime may be latanoprost (or other prostaglandin analogue) plus timolol LA which can both be administered once daily.

Miotics / sympathomimetics

Brimonidine tartrate

0.2% eye drops

Pilocarpine

1%, 2% eye drops 2% Minims eye drops 4% Pilogel 0.1% eye drops (diagnostic) (special ? Moorfields)

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