11.4.2 Other anti-inflammatory preparations

Iatrogenic allergy should be discounted for any allergic conjunctivitis. Common offenders are neomycin, framycetin, atropine, chloramphenicol, fusidic acid and benzalkonium chloride (preservative).

Nedocromil sodium (Rapitil®) has not been included in this formulary as it is a more expensive alternative to sodium cromoglicate (£4.92/5ml v £1.75/13.5ml). Although it may be used twice daily, treatment may require an increase to three/four times a day thus nullifying any advantage.

Sodium cromoglicate
  • Aqueous eye drops 2% (£4.41 = 13.5ml)
  • Single use eye drops 2% (£8.99 = 30 units)

Indications

  • Allergic conjunctivitis
  • Seasonal keratoconjunctivitis

Dose

  • Apply 4 times daily

Notes

  1. Sodium cromoglicate is a cheap, effective (particularly as a prophylactic) mast cell stabiliser. It should be instilled four times a day and may take a couple of days for maximal effect.
  2. Please ensure that prescriptions are written for 13.5ml, not 10ml or '1op' as these preparations are 'over-the-counter' products and are more expensive.
Olopatadine
  • Eye drops 1mg/ml (£4.68 = 5ml)

Indications

  • Seasonal allergic conjunctivitis

Dose

  • Apply twice daily, maximum duration of treatment 4 months
Ciclosporin
  • Ikervis® eye drops 1mg/ml 0.3ml single use eye drops(£72.00 = 30 units)
  • Eye drops 0.05% preservative free (unlicensed preparation)
  • Eye drops 0.06% preservative free (unlicensed preparation supplied from Moorfields)
  • Eye ointment 0.2% (unlicensed preparation)

Indication and dose

  • Treatment of severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes
    • Ikervis eye drops should be applied once daily to the affected eye(s) at bedtime

Notes

  1. Ikervis treatment must be initiated by an ophthalmologist, including first prescription
  2. Response to treatment with Ikervis should be reassessed at least every 6 months by specialist, and where appropriate repeat prescribing may be performed by primary care on specialist advice
  3. NICE TA369: Ciclosporin (Ikervis) 1mg/ml 0.3ml single use eye drops are recommended as an option for treating severe keratitis in adults with dry eye disease that has not improved despite treatment with tear substitutes (December 2015)

 

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