11.8.1 Tear deficiency, ocular lubricants, and astringents

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 dry eyes and sore tired eyes.

Many of these products 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.

Ointments should not be used during contact lens wear.

These drugs are used here, but are listed elsewhere in the formulary:

Ciclosporin, see 11.4.2 Other anti-inflammatory preparations

  • 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)

Mild dry eye

Patients requiring lubricant eye drops up to four times a day in both eyes
Polyvinyl Alcohol

Indications

  • Tear deficiency

Dose

  • Apply as required, up to four times a day

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Hypromellose
  • Eye drops 0.3% (£0.99 = 10ml)

Indications

  • Tear deficiency

Dose

  • Instil frequently for adequate relief

Notes

  1. Please ensure that the % of hypromellose is stated on all prescriptions, only the 0.3% is included in the formulary.

Moderate dry eye

Patient requiring lubricant eye drops four times a day in both eyes

Preservative-free preparations of lubricants should be prescribed if used regularly more than four times a day.

Patients using preservative-free eye drops in multiple-use containers could be at risk of serious eye infection due to microbial contamination of the product. Doctors should exercise caution when prescribing multiple-use eye drops without preservative in patients at high risk of infection.

Carbomers

Indications

  • Dry eyes including keratoconjunctivitis sicca, unstable tear film

Dose

  • Apply 3-4 times daily or as required

Notes

  1. The ability of carbomers to cling to the eye surface may help to reduce frequency of application to four times daily
  2. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)

Severe dry eye

Patient requiring lubricant eye drops 2 hourly during waking hours to both eyes
Sodium hyaluronate

Indications

  • Dry eye conditions

Dose

  • Apply as required

Notes

  1. Sodium hyaluronate is more expensive than other ocular lubricants but maybe more cost effective for patients who do not use an entire bottle every month as the drops remain sterile in the bottle for longer than 28 days after opening. Please refer to the individual product information and remind patients not to dispose of the bottle after 28 days
  2. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Thealoz Duo®

(Sodium hyaluronate 0.15% and trehalose 3%)

  • Eye drops - preservative free (£8.99 = 10mls)

Indications

  • Dry eye conditions

Dose

  • Apply as required

Notes

  1. For patients who cannot tolerate sodium hyaluronate 0.2%, or who have been diagnosed with severe dry eye and sodium hyaluronate 0.2% is not sufficient
  2. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
Polyvinyl Alcohol

Indications

  • Tear deficiency

Dose

  • Apply as required

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Hypromellose

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Carbomer

Indications

  • Dry eyes including keratoconjunctivitis sicca, unstable tear film

Dose

  • Apply 3-4 times daily or as required

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Carmellose

Indications

  • Dry eye conditions

Dose

  • Apply as required

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Patients with severe dry eye requiring lubricant at night to both eyes
Liquid Paraffin

Indications

  • Dry eye conditions
  • Recurrent corneal epithelial erosion

Dose

  • May cause temporary visual disturbance and is best suited for application before sleep, may be used in combination with artificial tear drops.

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)

Other preparations

Macrogols (polyethylene glycols)
  • Systane® eye drops (£7.49 = 10ml)
  • Systane® single use eye drops (£4.66 = 28 units)

Indications

  • Dry eye conditions

Dose

  • Apply as required

Notes

  1. Hydroxypropyl guar maybe more cost effective for patients who do not use an entire bottle every month as the drops remain sterile in the bottle for 6 months after opening. Remind patients not to dispose of the bottle after 28 days
Sodium chloride
  • Single use eye drops, sodium chloride 0.9% (£7.14 = 20 units)
  • Eye drops sodium chloride 5% (unlicensed preparation)
  • Eye ointment sodium chloride 5% (unlicensed preparation)
Acetylcysteine
  • Ilube® eye drops acetylcysteine 5%, hypromellose 0.35%
  • Eye drops acetylcysteine 5% preservative free (unlicensed preparation)
Light liquid paraffin
  • Eye drops 10ml (unlicensed)
Balanced Salt Solution (BSS)
  • Eye irrigation solutions 19ml, 500ml
BSS plus
  • Eye irrigation solutions 500ml

 

Home > Formulary > Chapters > 11. Eye > 11.8 Miscellaneous ophthalmic preparations > 11.8.1 Tear deficiency, ocular lubricants, and astringents

 

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