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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Review date: January 2023

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

 Details...
11.01  Administration of drugs to the eye
 note 

Eye drop dispensers

The Drug Tariff only lists the four eye drop dispensers below. Other products cannot be prescribed on NHS FP10 prescriptions.

Eye drop dispensers are classed as medical appliances and therefore must be included in Part IXA of the Drug Tariff to be allowable on an NHS prescription. Other eye drops dispensers are available, but cannot be prescribed on NHS prescriptions. When recommending eye drop dispensers it is important to ensure that the eye drops and the eye drop dispenser are compatible. They are particularly useful for the elderly, visually impaired, arthritic, or otherwise physically limited patients.

ComplEye
Formulary
Green
 
   
Opticare
Formulary
Green
For 2.5, 5, 10, 15 and 20 mL bottles 
   
Opticare Arthro 5
Formulary
Green
For 2.5 and 5 mL bottles 
   
Opticare Arthro 10
Formulary
Green
For 10, 15 and 20 mL bottles 
   
11.02  Control of microbial contamination
11.03  Anti-infective eye preparations
 note  The availability of unlicensed products may vary between secondary care organisations depending on local treatment protocols and pathways. If you are uncertain about product availability, contact your trust’s pharmacy department for advice.
11.03.01  Antibacterials
Chloramphenicol
View adult BNF View SPC online View childrens BNF
Formulary
Green

0.5% eye drops, 0.5% minims, 1% eye ointment

1st line for superficial eye infections e.g. conjunctivitis.
Ointment can be used once daily at night in combination with eye drops.
Chloramphenicol can be sold to the public over 2 years of age for the treatment of acute bacterial conjunctivitis.
Minims (single dose eye drops) reserved for patients with known preservative allergy.

 
   
Fusidic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
1% eye drops

 
   
Ciprofloxacin
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.3% eye drops, 0.3% eye ointment

 
   
Gentamicin
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.3% eye drops

 
   
Levofloxacin
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.5% eye drops, 0.5% unit dose eye drops

Single dose eye drops reserved for patients with known preservative allergy. 
   
Neomycin
View adult BNF View SPC online
Formulary
Amber Initiated
0.5% eye drops, 0.5% eye ointment

 
   
Ofloxacin Eye drops
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

0.3% eye drops

Consult local hospital for availability

 
   
Azithromycin
View adult BNF View SPC online View childrens BNF
Formulary
Red
1.5% eye drops

 
   
Propamidine isetionate
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.1% eye drops

Non-formulary for licensed indications.
Used off-label in the management of acanthamoeba keratitis. 
   
Cefuroxime
View adult BNF
Unlicensed Drug Unlicensed
Red
5% eye drops

 
   
Chlorhexidine
View adult BNF
Unlicensed Drug Unlicensed
Red
0.02% eye drops

 
   
Ceftazidime
View adult BNF
Unlicensed Drug Unlicensed
Red

5% eye drops
 
Ophthalmologist only.

 
   
Chlortetracycline
Unlicensed Drug Unlicensed
Red
1% eye ointment

 
   
Gentamicin
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

1.4% eye drops, 1.5% eye drops, 2% eye drops, 0.3% single dose eye drops

 
   
Polyhexamethylene biguanide (PHMB)
View adult BNF
Unlicensed Drug Unlicensed
Red

0.02% eye drops, 0.06% eye drops

No BNFc entry - seek specialist advice

 
   
Teicoplanin
View adult BNF
Unlicensed Drug Unlicensed
Red

1% eye drops

No BNFc entry - seek specialist advice

 
   
Vancomycin
View adult BNF
Unlicensed Drug Unlicensed
Red

5% eye drops

No BNFc entry - seek specialist advice

 
   
11.03.02  Antifungals to top
 note 


Amphotericin
View adult BNF
Unlicensed Drug Unlicensed
Red

0.15% and 0.3% eye drops. 

No BNFc entry - seek specialist advice.

 

 
   
Voriconazole
Unlicensed Drug Unlicensed
Red

1% eye drops (preservative-free).

No BNFc entry - seek specialist advice.

 
   
11.03.03  Antivirals
 note 


Ganciclovir
View adult BNF View SPC online
Formulary
Amber Initiated

0.15% ophthalmic gel

Administration during pregnancy or lactation is not recommended, except in the absence of an alternative treatment. Men are advised to use local contraceptive measure (as condom) during treatment and for up to three months thereafter.

 
   
Foscarnet
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

2.4% eye drops

Licensed for use in CMV retinitis in AIDs only

No BNFc entry - seek specialist advice

 
   
Trifluorothymidine
Unlicensed Drug Unlicensed
Red

1% eye drops

No BNFc entry - seek specialist advice.

 
   
11.03.04  Intra-ocular anti-infective preparations
11.03.04  Subconjunctival injections
 note 

Available in secondary care organisations. Contact your hospital's pharmacy department for advice on availability.

11.03.04  Intravitreal and intracameral injections
11.04  Corticosteroids and other anti-inflammatory preparations to top
11.04.01  Corticosteroids
 note 

The availability of unlicensed products may vary between secondary care organisations depending on local treatment protocols and pathways. If you are uncertain about product availability, contact your trust's pharmacy for advice.

Betamethasone sodium phosphate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

0.1% eye ointment

0.1% eye/ear/nose drops (Paediatrics only)

 
   
Dexamethasone
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.1% eye drops, 0.1% minims

Minims (single dose eye drops) reserved for patients with known preservative allergy

 
   
Fluorometholone
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.1% eye drops

May have less effect on intraocular pressure than prednisolone acetate or dexamethasone, but intraocular penetration is poor. 
   
Hydrocortisone
View adult BNF View SPC online
Formulary
Amber Initiated

0.335% preservative free eye drops

No BNFc entry - seek specialist advice

 
   
Loteprednol
View adult BNF View SPC online
Formulary
Amber Initiated
0.5% eye drops

May have less effect on intraocular pressure than prednisolone acetate or dexamethasone.
 
   
Prednisolone acetate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
1% eye drops

 
   
Prednisolone sodium phosphate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.5% eye drops, 0.5% minims

Minims (single dose eye drops) reserved for patients with known preservative allergy
Prednisolone sodium phosphate 0.5% is not half the strength of prednisolone acetate 1%

 
   
Prednisolone
View adult BNF
Unlicensed Drug Unlicensed
Red
Various strengths available
 
   
11.04.01  Corticosteroids combined with antimicrobials
 note 

Combination products containing a corticosteroid with an anti-infective are sometimes used after ocular surgery to reduce inflammation and prevent infection; use of combination products is otherwise rarely justified.

Red Local trust policies for post-operative use should be followed. Such use is designated RED

11.04.01  Intravitreal corticosteroids
 note  Two licensed intravitreal corticosteroids are available for use in line with NICE guidance. Other intraocular corticosteroid injections may be used in secondary care according to locally agreed policies and pathways. Please consult your hospital's pharmacy department for information about the availability of unlicensed corticosteroid injections.
Dexamethasone
View adult BNF View SPC online
Formulary
Red

intravitreal implant 700 micrograms

Ophthalmologist only.

Only to be used in line with NICE TA criteria for DMO, not approved for use in phakic patients.

 
Link  NICE (2011). Dexamethasone intravitreal implant for the treatment of macular oedema caused by retinal vein occlusion (RVO) [TA229]
Link  NICE (2015). Dexamethasone intravitreal implant for treating diabetic macular oedema [TA349]
Link  NICE (2017). Adalimumab and dexamethasone for treating non-infectious uveitis [TA460]
   
Fluocinolone acetonide
View adult BNF View SPC online
Formulary
Red

intravitreal implant 190 micrograms

Ophthalmologist only

For use in DMO: in line with criteria in NICE TA301, for pseudophakic patients only.
Black do not use for treatment of DMO in phakic patients, as per NICE TA613

 
Link  Pan Mersey APC (2019): Fluocinolone intravitreal implant (Iluvien®) for non-infectious uveitis
Link  Pan Mersey APC (2020): FLUOCINOLONE intravitreal implant (Iluvien®) for chronic diabetic macular oedema in phakic eyes
Link  NICE TA613 (2019): Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy
Link  NICE TA590 (2019): Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
Link  NICE TA301 (2013): Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
   
11.04.02  Other anti-inflammatory preparations
Antazoline 0.5% with Xylometazoline 0.05%
View adult BNF View SPC online View childrens BNF
Formulary
Green
eye drops 
   
Azelastine
View adult BNF View SPC online View childrens BNF
Formulary
Green
0.05% eye drops
 
   
Ketotifen
View adult BNF View SPC online View childrens BNF
Formulary
Green

0.25% preservative free eye drops

 
   
Lodoxamide
View adult BNF View SPC online View childrens BNF
Formulary
Green
0.1% eye drops.
Can be sold to the public for the treatment of allergic conjunctivitis in adults and children over 4 years 
   
Nedocromil
View adult BNF View SPC online View childrens BNF
Formulary
Green

2% eye drops

 
   
Olopatadine
View adult BNF View SPC online View childrens BNF
Formulary
Green
0.1% eye drops

Has antihistaminic and mast cell stabilising properties. 
   
Sodium Cromoglicate
View adult BNF View SPC online View childrens BNF
Formulary
Green
2% eye drops
Can be sold to the public for the treatment of acute seasonal and perennial allergic conjunctivitis 
   
11.05  Mydriatics and cycloplegics to top
11.05  Antimuscarinics
 note 


Cyclopentolate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
0.5% eye drops, 0.5% minims, 1% eye drops, 1% minims 
   
Atropine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

1% eye drops, 1% minims

 
   
Tropicamide
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.5% eye drops, 0.5% minims, 1% eye drops, 1% minims 
   
11.05  Sympathomimetics
 note 


Phenylephrine
View adult BNF View SPC online View childrens BNF
Formulary
Red
2.5% and 10% minims
 
   
11.06  Treatment of glaucoma
 note 


11.06  Beta-blockers
 note 


Timolol
View adult BNF View SPC online View childrens BNF
First Choice
Amber Recommended

0.25% eye drops, 0.25% preservative-free eye drops

0.5% eye drops, 0.5% preservative-free eye drops.

 

Amber Initiated Paediatrics.

 
Betaxolol
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

0.25% eye drops, 0.25% single dose eye drops, 0.5% eye drops.
Cardioselective - theoretically beneficial in patients with respiratory disease.
Single dose eye drops reserved for patients with known preservative allergy.

Amber Initiated Paediatrics.

 
   
Levobunolol
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

0.5% eye drops, 0.5% single dose eye drops
Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
   
Timolol (other preparations)
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

0.25% and 0.5% long acting ophthalmic gel forming solution, 0.1% unit dose eye gel.
Unit dose eye gel reserved for patients with known preservative allergy.

Amber Initiated Paediatrics.

 
   
11.06  Prostaglandin analogues and prostamides to top
 note  There is no evidence to suggest that one prostaglandin analogue/prostamide is more efficacious than the other agents. Latanoprost may offer greater ocular tolerability.
Latanoprost
View adult BNF View SPC online View childrens BNF
First Choice
Amber Recommended

50 micrograms/ mL (0.005%) eye drops, 50 micrograms/ml (0.005%) single dose eye drops
Single dose eye drops reserved for patients with known preservative allergy.

Amber Initiated Paediatrics.

 
Bimatoprost
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

100 micrograms/ mL (0.01%) and 300 micrograms/ mL (0.03%) eye drops,

300 micrograms/ ml (0.03%) single dose eye drops
Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
   
Tafluprost
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

15 micrograms/ml (0.0015%) single dose eye drops

Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated  Paediatrics

 
   
Travoprost
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

40 micrograms/ mL (0.004%) eye drops
Travatan brand does not contain benzalkonium chloride as the preservative and therefore may be used in patients where a known allergy to benzalkonium chloride exists. Generic version and Bondulc brand contain benzalkonium chloride.

Amber Initiated Paediatrics.

 
   
11.06  Combination products – prostaglandin anologues with timolol
 note 


Latanoprost with timolol
View adult BNF View SPC online View childrens BNF
First Choice
Amber Recommended

50 micrograms/ml (0.005%) and 5mg/ml (0.5%) eye drops

Preservative-free 50 micrograms/ml (0.005%) and 5mg/ml (0.5%) eye drops. Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
Bimatoprost with timolol
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

300 micrograms/ml (0.03%) and 5mg/ml (0.5%) eye drops, 300 micrograms/ml (0.03%) and 5mg/ml (0.5%) single dose eye drops
Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
   
Travoprost with timolol
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

40 micrograms/ml (0.004%) and 5mg/ml (0.5%) eye drops

Does not contain benzalkonium chloride as the preservative and therefore may be used in patients where a known allergy to benzalkonium chloride exists.

Amber Initiated Paediatrics.

 
   
Tafluprost with timolol
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

15 micrograms/ml (0.0015%) and 5mg/ml (0.5%) unit dose eye drops
Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
   
11.06  Sympathomimetics
 note 


Brimonidine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

0.2% eye drops

Amber Initiated Paediatrics.

 
   
11.06  Combination products – sympathomimetics plus timolol
 note   
Brimonidine with timolol
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

0.2% and 0.5% eye drops

Amber Initiated Paediatrics.

 
   
11.06  Combination products – sympathomimetic plus carbonic anhydrase inhibitors
Brimonidine with brinzolamide
View adult BNF View SPC online
Formulary
Amber Recommended

2mg/ml (0.2%) and 10mg/ml (1%) eye drops

No BNFc entry - seek specialist advice.

 
   
11.06  Carbonic anhydrase inhibitors – topical preparations to top
 note 


Brinzolamide
View adult BNF View SPC online View childrens BNF
First Choice
Amber Recommended

10 mg/ mL (1%) eye drops

Amber Initiated Paediatrics.

 
Dorzolamide
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

2% eye drops, 2% single dose eye drops
Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
   
11.06  Combination products – topical carbonic anhydrase inhibitors with timolol
 note  Combination products should be restricted to patients with compliance issues or those who have difficulty administering eye drops.
Brinzolamide with timolol
View adult BNF View SPC online View childrens BNF
First Choice
Amber Recommended

10mg/ml (1%)and 5mg/ml (0.5%) eye drops

Amber Initiated Paediatrics.

 
Dorzolamide with timolol
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended

2% and 5% eye drops, 2% and 5% single dose eye drops
Single dose eye drops reserved for patients with known preservative allergy

Amber Initiated Paediatrics.

 
   
11.06  Carbonic anhydrase inhibitors – systemic agents
 note 


Acetazolamide
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

250mg tablets, 250mg m/r capsules

Amber Initiated Paediatrics.

 
   
Acetazolamide
View adult BNF View SPC online View childrens BNF
Formulary
Red
500mg injection 
   
11.06  Miotics
Pilocarpine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

1% eye drops, 2% eye drops, 4% eye drops, 2% single dose eye drops

Amber Initiated Paediatrics.

 
   
Pilocarpine
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Red
All other preparations 
   
11.07  Local anaesthetics
Lidocaine Hydrochloride 4% with Fluorescein 0.25%
View adult BNF View SPC online View childrens BNF
Formulary
Red
minims

 
   
Oxybuprocaine
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.4% minims 
   
Proxymetacaine
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.5% minims

 
   
Tetracaine
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.5% minims and 1% minims

 
   
11.08  Miscellaneous ophthalmic preparations to top
11.08.01  Tear deficiency, ocular lubricants, and astringents
 note 

The formulary advice on the use of ocular lubricants for tear deficiency, dry eyes syndrome, and associated conditions can be found in the Pan Mersey dry eye guidance.

Pan Mersey APC (2020). DRY EYE SYMPTOMS, non-specialist management.

NICE (2015). Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears.

11.08.01  Initial management of dry eyes in primary care
Hypromellose
View adult BNF View SPC online View childrens BNF
First Choice
Green

0.3% eye drops (10ml)
0.3% single use eye drops, preservative free
0.3% eye drops (10ml), preservative free

 
Polyvinyl alcohol
View adult BNF View SPC online View childrens BNF
First Choice
Green
Eye drops 1.4% (Sno-Tears®)

Ophthalmic solution preservative free 1.4% (Liquifilm Tears®PF) 
Carbomer 980
View adult BNF View SPC online View childrens BNF
Second Choice
Green
0.2% eye drops
0.2% eye gel (Artelac Nighttime gel, Clinitas Carbomer gel, Lumecare Long Lasting gel)
0.2% preservative free eye gel (Xailin, Viscotears unit dose) 
   
Carmellose
View adult BNF View SPC online View childrens BNF
Third Choice
Green
Optive Fusion® (carmellose sodium 0.5% / sodium hyaluronate 0.1%, 10ml)
Celluvisc® 0.5% single dose eye drops (30 units), preservative free
Xailin Fresh® (carmellose sodium 0.5%, 30 units), preservative free 
   
Hydroxypropyl Guar
View adult BNF View SPC online View childrens BNF
Third Choice
Green
Systane® eye drops (10ml)

Systane® single dose eye drops (28 units), preservative-free 
   
Sodium hyaluronate
View adult BNF View childrens BNF
Third Choice
Green

Eye drops

Hylo-Tear® eye drops (sodium hyaluronate 0.1%, 10ml), preservative-free

Artelac Rebalance® eye drops (sodium hyaluronate 0.15%, 10ml)

Lumecare® eye drops (sodium hyaluronate 0.15%, 10ml)

Hyabak® eye drops (sodium hyaluronate 0.15%, 10ml), preservative-free

Vismed® eye drops (sodium hyaluronate 0.18%, 10ml), preservative-free

Evolve HA® eye drops (sodium hyaluronate 0.2%, 10ml), preservative-free - preferred choice to Hylo-forte®  - counsel patient that container is softer than conventional container requiring less pressure to administer single drop.


Hylo-Forte® eye drops (sodium hyaluronate 0.2%, 10ml), preservative-free - second choice after Evolve HA® 

Vismed® eye gel (sodium hyaluronate 0.3%, 10ml), preservative-free

Thealoz Duo® eye drops (sodium hyaluronate 0.15%, trehalose 3%, 10mL), preservative-free


Single use eye drops

Vismed® single dose eye drops (sodium hyaluronate 0.18%, 20 units), preservative-free

Vismed® single dose eye gel (sodium hyaluronate 0.3%, 20 units), preservative-free

Clinitas® single dose eye drops (sodium hyaluronate 0.4%, 30 units), preservative-free

Thealoz Duo® gel eye drops (sodium hyaluronate 0.15%, trehalose 3%, carbomer 0.25%, 30 units), preservative-free

 
   
Paraffins
View adult BNF View childrens BNF
Fourth Choice
Green
Lacri-Lube® eye ointment, preservative-free
VitA-Pos® eye ointment, preservative-free
Xailin® Night, preservative-free
Simple eye ointment, preservative-free

Reserved for severe disease or for patients who require additional night time dosing in addition to daytime eye drops. 
   
Eye compress
Formulary
Black

Hot Eye Compress®

Meibopatch®

MGDRx Eye Bag®

 
   
11.08.01  Ocular surface disease – diagnosed and managed by secondary care
Acetylcysteine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

5% eye drops, 10ml (Ilube)

 
   
Carmellose
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Optive Plus (carmellose sodium 0.5% with glycerol and castor oil, 10ml)

Celluvisc 1% single dose eye drops (30 units)preservative-free

 
   
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Amber Retained

1mg/mL eye drops (Verkazia brand) - licensed for severe venal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents

 
Link  Pan Mersey APC (2019): CICLOSPORIN 1mg/mL eye drops (Verkazia®) for the treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents
   
Ciclosporin
View adult BNF View SPC online
Formulary
Amber Initiated

1 mg/mL eye drops (Ikervis brand) - licensed preparation

 

 
Link  NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
   
Hyaluronic acid 0.1%, co-enzyme Q 0.1%, vitamin E TPGS 0.5%
View adult BNF
Formulary
Amber Recommended

VisuXL® , 10mL

Severe dry eyes - Sjogren's syndrome, chronic keratitis.

 
   
Hydroxypropyl Guar
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Systane Ultra® eye drops 10ml
Single dose eye drops

 
   
Hypromellose (Isopto Alkaline®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

1% eye drops 10ml

 
   
Hypromellose (Isopto Plain®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

0.5% eye drops 10ml

 
   
Sodium Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

0.9% single use eye drops

Preservative Free

 
   
Sodium Hyaluronate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

0.1% eye drops, 10ml, preservative free (Hylo-Tear)
0.15% eye drops, 10ml (Artelac Rebalance, Lumecar)
0.15% eye drops, 10ml, preservative free (Hyabak)
0.18% eye drops, 10ml, preservative free (Vismed)
0.18% eye drops, single dose, preservative free (Vismed)
0.2% eye drops, 10ml, preservative free (Hylo-Forte)
0.3% eye gel, 10ml, preservative free (Vismed)
0.3% eye gel, single dose, preservative free (Vismed)
0.4% eye drops, resealable, preservative free (Clinitas)

 
   
Sodium hyaluronate 0.1% with dexpanthenol 2%
View adult BNF View childrens BNF
Formulary
Amber Recommended

Hylo-Care® eye drops, preservative-free

 
   
Hypromellose
View adult BNF
Unlicensed Drug Unlicensed
Red
2% eye drops
For use with fundus lenses and gonioscopy lenses 
   
Collagen implants (’Shields’)
Unlicensed Drug Unlicensed
Red
For temporary diagnostic occlusion of puncta in dry eye syndrome 
   
Ciclosporin
View adult BNF
Unlicensed Drug Unlicensed
Red

0.05% single use eye drops, preservative free 0.06% eye drops, preservative free 0.2% eye ointment, preservative-free 2% eye drops, preservative-free Ophthalmologist only. For severe dry eyes syndrome.  

 

 
   
11.08.02  Ocular diagnostic and peri-operative preparations and photodynamic treatment
11.08.02  Ocular diagnostic preparations to top
 note  Fluorescein may be administered as a diagnostic aid in examination of the eye by competent practitioners. There are no indications for prescribing fluorescein.
11.08.02  Ocular peri-operative drugs
 note 


Apraclonidine
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Formulary
Red

0.5% eye drops and 1% single dose eye drops

 

Amber Recommended 

Apraclonidine eye preparations may be recommended by specialists for the management of chronic glaucoma that is unresponsive to therapy in patients who would otherwise require surgery for their disease. Patients must have tried and failed, or had an adverse reaction, on all standard therapies before apraclonidine may be prescribed.

Apraclonidine 0.5% eye drops are licensed for short-term adjunctive therapy of chronic glaucoma in patients on maximally tolerated medical therapy who require additional intraocular pressure (IOP) reduction to delay laser treatment or glaucoma surgery. Use of 1% preservative-free preparation, or 0.5% eye drops other than previously described, is off-label. The ophthalmologist should clearly communicate the rationale for prescribing apraclonidine in the clinic letter to primary care.

Apraclonidine 1% preservative-free preparations must only be prescribed for patients who have a clearly documented allergy to preservatives contained in eye drops.

 
   
Bromfenac
View adult BNF View SPC online
Formulary
Red
0.09% eye drops

 
   
Diclofenac
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Formulary
Red
0.1% eye drops, 0.1% unit dose eye drops

 
   
Flurbiprofen 0.03% & polyvinyl alcohol 1.4%
View adult BNF View SPC online View childrens BNF
Formulary
Red
eye drops

 
   
Ketorolac
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.5% eye drops

 
   
Nepafenac
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Formulary
Red
1mg/ml (0.1%) eye drops 
   
Povidone-iodine
View adult BNF View SPC online View childrens BNF
Formulary
Red
5% single dose eye drops 
   
11.08.02  Subfoveal choroidal neovascularisation
Aflibercept
View adult BNF View SPC online
Formulary
Red

solution for intravitreal injection
 

 
Link  NICE TA294: Aflibercept to treating wet age-related macular degeneration
Link  NICE TA305: Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA346: Aflibercept for treating diabetic macular oedema
Link  NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
Link  NICE TA486: Aflibercept for treating choroidal neovascularisation
   
Ranibizumab
View adult BNF View SPC online
Formulary
Red

Solution for intravitreal injection

Grey for treatment of diabetic retinopathy

 
Link  NICE TA155 (2012). Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA274 (2013). Ranibizumab for treating diabetic macular oedema
Link  NICE TA283 (2013). Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA298 (2013). Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
Link  Pan Mersey APC (2019). RANIBIZUMAB solution for injection (Lucentis®) for the treatment of proliferative diabetic retinopathy
Link  Pan Mersey APC (2019). RANIBIZUMAB intravitreal injection (Lucentis®) for choroidal neovascularisation (non-NICE indications)
   
Pegaptanib
View adult BNF View SPC online
Formulary
Black
solution for intravitreal injection
Not recommended – see NICE TA155 
Link  NICE TA155, Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
   
Bevacizumab
View adult BNF
Unlicensed Drug Unlicensed
Red
Intravitreal injection

For pre-specified indications or as part of a clinical trial only. 
   
11.08.02  Vitreomacular traction
Ocriplasmin
View adult BNF View SPC online
Formulary
Red
intravitreal injection 
Link  NICE TA297: Ocriplasmin for treating vitreomacular traction
   
11.10  Additional treatments used in the management of ophthalmic conditions not listed in BNF chapter 11
 note 

See chapter 8 for oral immunosuppressive agents used in the management of uveitis and associated conditions.

Adalimumab
View adult BNF View SPC online
Formulary
Red

Injection 40 mg prefilled pen or prefilled syringe

NHS NHSE commissioned drug for non-infectious uveitis (in line with NICE TA 460) - see Specialised Commissioning: Key documents

Amgevita® biosimilar brand

Hulio® biosimilar brand

Hyrimoz® biosimilar brand

Imraldi® biosimilar brand

Humira® originator brand  

Prescribe by brand name

 
Link  NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis
   
Alcohol
View adult BNF
Formulary
Red
20% eye drops 
   
Ascorbic acid
View adult BNF View SPC online View childrens BNF
Formulary
Red

10% eye drops

 
   
Botulinum toxin type A
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Formulary
Red
Injection
For blepharospasm, hemifacial spasm, squint and protective ptosis.
Various brands available – contact your hospital's pharmacy department for further advice. 
   
CenegerminBlack Triangle
View adult BNF View SPC online
Formulary
Black

20 micrograms/ml eye drops

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents. As per IFR approval. No BNFc entry – seek specialist advice

 
Link  NICE TA532: Cenegermin for treating neurotrophic keratitis
   
Cocaine
View adult BNF
Formulary
Red
4% and 10% eye drops
 
   
Cytotoxic Drug Fluorouracil
View adult BNF
Formulary
Red

1% eye drops

 
   
Glycerin
View adult BNF
Formulary
Red
Eye drops

 
   
Interferon Alfa-2b
View adult BNF
Formulary
Red
1,000,000 units/ml eye drops 
   
Cytotoxic Drug Mitomycin
View adult BNF
Formulary
Red

0.04% eye drops

 
   
Sodium Chloride
View adult BNF
Formulary
Red
5% eye drops, 5% eye ointment, 5% preservative-free eye drops 
   
Lutein, zeaxanthin, omega-3 fatty acids and beta carotene containing products
Formulary
Black
 
Link  Antioxidant supplements for Age-Related Macular Degeneration, Pan Mersey APC Prescribing Policy Statement
   
Sodium citrate
View adult BNF
Unlicensed Drug Unlicensed
Red

6.5% eye drops

 
   
11.99.99.99  Miscellaneous to top
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

netFormulary