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11.1 Allergic and inflammatory eye conditions

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only 
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

11.1.1 Allergic conjunctivitis

 

Allergies

Most people with mild to moderate symptoms are able to relieve symptoms with OTC treatments recommended by a pharmacist. Prescriptions should not routinely be offered.

 

 

Antihistamines

 

Mast-cell stabilisers

Sodium cromoglicate

  • Aqueous eye drops 2% 

Notes:

  • 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.
  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use

 

 

Olopatadine  (Amber 2)

  • Eye drops 1mg/ml    

Notes:

  • Olopatadine should be reserved for those circumstances where treatment with sodium cromoglicate has failed.
  • Treatment with olopatadine should be limited to a maximum of 4 months.

 

 

11.1.2 Inflammatory eye conditions

 

Corticosteroids

 

Betamethasone  (Amber 2)

  • Eye ointment: betamethasone 0.1%  

Notes:

  • Inflammation in anterior segment; post-operatively to reduce inflammation following Trabeculectomy

 

Dexamethasone  (Amber 2)

  • Eye drops 0.1%, hypromellose 0.5%
  • Single use eye drop 0.1%

 

Fluorometholone  (Amber 2)

  • Ophthalmic suspension 0.1% 

           

 

Prednisolone  (Amber 2)

  • Eye drops 0.5% 
  • Single use eye drop 0.5% Minims® Prednisolone Sodium Phosphate
  • Single use eye drops 0.1% U
  • Pred Forte® 1%  Eye Drops Suspension (for prevention of an ocular toxic reaction presenting as conjunctivitis or keratitis in patients who are treated with high-dose cytarabine treatment)

 

Notes:

  • Topical steroids should not be used for undiagnosed red eye.
  • If red eye is due to herpes simplex, corticosteroids will aggravate this condition possibly leading to loss of vision or even loss of the eye.
  • Steroid eye drops can raise intra-ocular pressure (IOP) and therefore precipitate glaucoma in patients pre-disposed to chronic simple glaucoma.
  • Evidence suggests that fluorometholone is less likely to raise IOP though this may be due to reduced penetration of the cornea.
  • A steroid cataract may follow prolonged use of topical steroids.

 

 

Dexamethasone intravitreal implant

  • Ozurdex® Intravitreal implant containing dexamethasone 700 micrograms in disposable applicator

Notes:

 

 

 

Fluocinolone acetonide intravitreal implant

  • Iluvien®Intravitreal implant containing fluocinolone acetonide 190 micrograms in a disposable applicator

Note:

 

Loteprednol etabonate

  • Eye drops: Loteprednol etabonate 0.5%

Notes:

  • (Apart from postoperative situation) for steroid responder patients requiring topical steroids

 

 

Corticosteroids combinations with anti-infectives    

 

Betnesol-N (Amber 2)

  • Eye drops: betamethasone sodium phosphate 0.1%, neomycin sulphate 0.5% 
  • Eye ointment: betamethasone sodium phosphate 0.1%, neomycin sulphate 0.5% 

 

Maxitrol® (Amber 2)

  • Eye drops: dexamethasone 0.1%, hypromellose 0.5%, neomycin 0.35%, polymixin B sulphate 6000 units/ml
  • Eye ointment: dexamethasone 0.1%, neomycin 0.35%, polymixin B sulphate 6000 units/ml

Notes:

  • Use of a combination product containing a steroid plus antibiotic is rarely justified and should not be routinely used, except post intraocular surgery e.g. cataract  

 

 

Immunosuppressants

Ciclosporin (Amber 3) 

  • Ikervis® 1mg/mL eye drops, emulsion

Notes:

 

 

Adalimumab 

  • Imraldi, Injection, 40mg/0.8mL prefilled pen or prefilled syringe
  • Amgevita, Injection, 20mg/0.4mL; 40mg/0.8mL prefilled pen or prefilled syringe
  • Humira, Injection, 40mg/0.4mL; 80mg/0.8mL prefilled pen or prefilled syringe
  • Humira, Injection, 20mg/0.2mL pre-filled syringe, 40mg/0.8mL solution in vial for first line use in paediatrics

Notes:

  • To be prescribed by brand.
  1. First line brand in adults = Imraldi®
  2. Second line brand in adults = Amgevita®
  3. Third line brand in adults = Humira®

 

 

 

Anterior Uveitis

Atropine Sulphate (Amber 2)

  • Eye drops 1%
  • Minims® Single use unit dose eye drops 1%

Notes:

  • Atropine has long activity, sometimes up to a week.
  • It is used to treat anterior uveitis to prevent posterior synechiae.
  • Atropine has a tendency to cause hypersensitivity.

 

Cyclopentolate hydrochloride  (Amber 2)

  • Eye drops 0.5%, 1% 
  • Minims® Single use unit dose eye drops 0.5%, 1% 

     

     

     

     

    Traffic light status (TLS) explained:

    • Green: Routine prescribing within licensed indication
    • Amber 1: specialist recommendation followed by GP initiation and continuation
    • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
    • Amber 3: specialist initiation and stabilisation followed by GP continuation
    • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
    • Red: Hospital or specialist prescribing only
       

Return to Chapter: 11. Eye

Last updated by: Dupe Fagbenro on 31-01-2019 12:44