11: Eye
Approved: 1 Jan 2013. Last amended: 19 Mar 2024.
On this page
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Administration of drugs to the eye
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Control of microbial contamination
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Anti-infective eye preparations
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Corticosteroids and other anti-inflammatory preparations
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Mydriatics and cycloplegics
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Treatment of glaucoma
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Local anaesthetics
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Miscellaneous ophthalmic preparations (inc. Dry Eye Guideline)
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Contact lenses
11.1 Administration of drugs to the eye
Refer to BNF for guidance regarding administration of eye drops, ointments and lotions.
11.2 Control of microbial contamination
Refer to BNF and local guidelines for information regarding the control of microbial contamination.
11.3 Anti-infective eye preparations
11.3.1 Antibacterials
Recommended
Chloramphenicol 0.5%
Eye drops
Chloramphenicol 1%
Eye ointment
Alternative
Ciprofloxacin 0.3%
Eye drops
Fusidic acid 1%
Eye drops in gel basis
Gentamicin 0.3%
Eye drops
Ofloxacin 0.3%
Eye drops
Specific Indication
Gentamicin 1.5%
Eye drops – hospital only
Polymixin B sulphate
Eye ointment (Polyfax®) – facial lacerations N.B. This is not the topical ointment
11.3.2 Antifungals
Not recommended
11.3.3 Antivirals
Recommended
Aciclovir 3%
Eye ointment
11.4 Corticosteroids and other anti-inflammatory preparations
11.4.1 Corticosteroids
Recommended
Betamethasone 0.1%
Eye drops or ointment
Prednisolone 0.5%
Eye drops (Predsol®)
Prednisolone 1%
Eye drops (Pred Forte®)
Dexamethasone 0.1%
Eye drops (Maxidex®)
Dexamethasone 0.1% & tobramycin 0.3%
Eye drops (Tobradex®)
Specific Indication
Prednisolone 0.5%
Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops
Dexamethasone 0.1%
Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops
Loteprednol 0.5%
Post-operative inflammation in patients with elevated eye pressures or known steroid-induced elevated eye pressure response to recommended topical steroids
11.4.2 Intravitreal corticosteroids
Specific Indication
Dexamethasone
Intravitreal implant
- Macular oedema due to retinal vein occlusion NICE TA229
- Diabetic macular oedema NICE TA824
Fluocinolone acetonide
Intravitreal implant
- Recurrent non-infectious uveitis NICE TA590
- Diabetic macular oedema NICE TA953
11.4.3 Other anti-inflammatory preparations
Recommended
Sodium cromoglicate 2%
Eye drops
Note: As per NHS England advice, patients should be directed to purchase sodium cromoglicate over-the-counter for allergic conjunctivitis
Specific Indication
Olopatadine
Eye drops
Second-line when sodium cromoglicate is ineffective
Ketotifen
Ketofall® Eye drops
Third-line when sodium cromoglicate is ineffective and patient has a documented preservative allergy
11.5 Mydriatics and cycloplegics
11.5.1 Antimuscarinics
To examine the fundus of the eye tropicamide 0.5% eye drops should be used.
Recommended
Cyclopentolate 0.5% or 1%
eye drops
Specific Indication
Cyclopentolate 0.5% or 1%
Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops
Tropicamide 0.5% or 1%
Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops
11.5.2 Sympathomimetics
Recommended
Phenylephrine 2.5%
Single-use eye drops (Minims®)
Specific Indication
Mydriasert®
Tropicamide and phenylephrine ophthalmic insert.
Restricted to use prior to cataract surgery.
Mydrane®
Tropicamide, phenylephrine and lidocaine solution for intracameral injection.
Restricted for use in patients where mydriasis with topical treatment is inadequate prior to cataract surgery.
11.6 Treatment of glaucoma
11.6.1 Beta-blockers
Recommended
Timolol 0.25% or 0.5%
Eye drops
Alternative
Betaxolol 0.5%
Eye drops
Specific Indication
Timolol 0.25% or 0.5%
Single-use eye drops – patients who are allergic to preservative containing eye drops
11.6.2 Prostaglandin analogues and prostamides
Recommended
Latanoprost 50mcg/ml
Eye drops
Specific Indication
Travoprost 40mcg/ml
Eye drops – patients who are unable to tolerate latanoprost
Bimatoprost 0.1mg/ml
Eye drops – patients who are unable to tolerate latanoprost
11.6.2.1 Preservative Free
Note: Preservative free eye drops may only be prescribed for patients who have a demonstrated allergy or intolerance to the preservative benzalkonium chloride
Recommended
Latanoprost 50mcg/ml
Single-use eye drops
Specific Indication
Bimatoprost 0.3mg/ml
Single-use eye drops – patients who are allergic to preservative containing eye drops and for whom single-use latanoprost is not suitable
11.6.3 Prostaglandin analogues and prostamides with timolol
Recommended
Latanoprost 50mcg/ml + timolol 5mg/ml
Eye drops
Specific Indication
Travoprost 40mcg/ml + timolol 5mg/ml
Eye drops – patients who are unable to tolerate latanoprost + timolol
Bimatoprost 0.3mg/ml + timolol 5mg/ml
Eye drops – patients who are unable to tolerate latanoprost + timolol
11.6.3.1 Preservative Free
Note: Preservative free eye drops may only be prescribed for patients who have a demonstrated allergy or intolerance to the preservative benzalkonium chloride
Specific Indication
Bimatoprost 0.3mg/ml + timolol 5mg/ml
Single-use eye drops – patients who are allergic to preservative containing eye drops
11.6.4 Sympathomimetics
Recommended
Brimonidine 0.2% eye drops
11.6.4.1 With timolol
Recommended
Brimonidine 0.2% + timolol 0.5%
Eye drops
11.6.4.2 With brinzolamide
Recommended
Brimonidine 0.2% + brinzolamide 1%
Eye drops
11.6.5 Miotics
Recommended
Pilocarpine 1%, 2% or 4%
Eye drops
Specific Indication
Pilocarpine 2% or 4%
Single-use eye drops (Minims®) – patients who are allergic to preservative containing eye drops
11.6.6 Carbonic anhydrase inhibitors and systemic drugs
11.6.6.1 Oral
Recommended
Acetazolamide
(oral)
11.6.6.2 Topical
Recommended
Dorzolamide 2%
Eye drops
Specific Indication
Brinzolamide 10mg/ml
Eye drops – patients who are unable to tolerate dorzolamide
Dorzolamide 2%
Single-use eye drops – patients who are allergic to preservative containing eye drops
11.6.6.3 With Timolol
Recommended
Dorzolamide 2% & timolol 0.5%
Eye drops
Specific Indication
Brinzolamide 10mg/ml + timolol 5mg/ml
Eye drops – patients who are unable to tolerate dorzolamide + timolol
Dorzolamide 2% + timolol 0.5%
Single-use eye drops – patients who are allergic to preservative containing eye drops
11.7 Local anaesthetics
Oxybuprocaine 0.4%
Single use eye drops (Minims®)
11.8 Miscellaneous ophthalmic preparations (inc. Dry Eye Guideline)
11.8.1 Tear deficiency, ocular lubricants and astringents
Local Guideline: Dry Eye Syndromes
Please note: Patients with mild dry eye disease should be directed to self-care with OTC preparations
11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment
Specific Indication
Fluorescein 2%
Single-use eye drops (Minims®)
Ketorolac 0.5%
Eye drops
Nepafenac 1mg/ml
Eye drops – prophylaxis against postoperative macular oedema associated with cataract surgery in diabetic patients
Aflibercept
- Age related macular degeneration, as per NICE TA294
- Macular oedema (retinal vein occlusion), as per NICE TA305, NICE TA409
- Diabetic macular oedema, as per NICE TA346
- Chorioidal neovascularisation, as per NICE TA486
Bevacizumab
- Wet age-related macular degeneration (off-label)
Brolucizumab
- Wet age-related macular degeneration, as per NICE TA672
- Diabetic macular oedema, as per NICE TA820
Faricimab
- Diabetic macular oedema, as per NICE 799
- Wet age-related macular degeneration, as per NICE TA800
Ocriplasmin
- Vitreomacular traction, as per NICE TA297
Ranibizumab
- Age related macular degeneration, as per NICE TA155
- Diabetic macular oedema, as per NICE TA274
- Macular oedema (retinal vein occlusion), as per NICE TA283
- Choroidal neovascularisation in people who also have pathological myopia, as per NICE TA298
11.8.3 Other Miscellaneous Preparations
Specific Indication
Adalimumab
Non-infectious uveitis, as per NICE TA460
Ciclosporin
- 1mg/ml eye drops (Ikervis®) – for treating severe keratitis in adult patients with dry eye disease that has not improved despite treatment with tear substitutes (see dry eye treatment guideline), as per NICE TA369. See Shared Care Guideline.
Ciclosporin
- 1mg/ml eye drops (Verkazia®) - for treating severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents.
Holoclar®
(Ex vivo expanded autologous human corneal epithelial cells containing stem cells) for treating limbal stem cell deficiency after eye burns, as per NICE TA467
Voretigene neparvovec
Inherited retinal dystrophies caused by RPE65 gene mutations, as per NICE HST11
11.9 Contact lenses
Refer to BNF for recommendations regarding contact lenses and drug treatment.
On this page
-
Administration of drugs to the eye
-
Control of microbial contamination
-
Anti-infective eye preparations
-
Corticosteroids and other anti-inflammatory preparations
-
Mydriatics and cycloplegics
-
Treatment of glaucoma
-
Local anaesthetics
-
Miscellaneous ophthalmic preparations (inc. Dry Eye Guideline)
-
Contact lenses