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Pan Mersey
Area Prescribing Committee
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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Review date: July 2019 (currently under review)

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

Chapter Links...
 Details...
11.08.01  Expand sub section  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.

http://www.panmerseyapc.nhs.uk/guidelines/documents/G18.pdf

http://www.panmerseyapc.nhs.uk/recommendations/documents/PS146.pdf

https://www.nice.org.uk/guidance/ta369

11.08.01  Expand sub section  Initial management of dry eyes in primary care
11.08.01  Expand sub section  Ocular surface disease – diagnosed and managed by secondary care
 note 


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
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
   
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

 
   
Acetylcysteine
View adult BNF
Unlicensed Drug Unlicensed
Red
5% and 10% eye drops
Preservative-free
Ophthalmologist only. pH approx. 8.5 
   
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.  

 

 
   
 ....
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.  

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