NHS England (NHSE) has published new prescribing
guidance for various common conditions for which over-the-counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include mild to moderate hay fever/seasonal allergic rhinitis.
Products such as sodium cromoglicate eye drops are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click
here for further information, exceptions, and a patient leaflet.
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.
- Aqueous eye drops 2% (£4.41 = 13.5ml)
- Single use eye drops 2% (£8.99 = 30 units)
- Allergic conjunctivitis
- Seasonal keratoconjunctivitis
- 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.
- 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.
- Eye drops 1mg/ml (£4.68 = 5ml)
- Seasonal allergic conjunctivitis
- Apply twice daily, maximum duration of treatment 4 months
- 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
- Ikervis treatment must be initiated by an ophthalmologist, including first prescription
- 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
- 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)
11. Eye >
11.4 Corticosteroid and other anti-inflammatory preparations >
11.4.2 Other anti-inflammatory preparations
- First line
- Second line