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11.3 Eye Infections

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.

 

 

11.3.1 Bacterial eye infections

 

Eye Infections

Treatment isn’t usually needed for conjunctivitis unless the patient has red flag symptoms as the symptoms usually clear within a week. There are several self-care measures that may help with symptoms.

If treatment is needed, then treatment is dependent on the cause:

·         In severe bacterial cases, antibiotic eye drops and eye ointments can be used to clear the infection.

·         Irritant conjunctivitis will clear up as soon as whatever is causing it is removed.

·         Allergic conjunctivitis can usually be treated with anti-allergy medications such as antihistamines. The substance that caused the allergy should be avoided.

Treatments for conjunctivitis can be purchased over the counter; however almost half of all simple cases of conjunctivitis clear up within ten days without any treatment.

Public Health England (PHE) advises that children with infective conjunctivitis do not need to be excluded from school, nursery or child minders, and it does not state any requirement for treatment with topical antibiotics.

 

Antibacterials

 

Chloramphenicol

  • Eye drops 0.5% 
  • Single use eye drop 0.5%
  • Eye ointment 1%

Notes:

  • Chloramphenicol is the drug of choice for superficial eye infections. It has a broad spectrum of activity and is associated with a low level of resistance.
  • Should not be routinely prescribed in Primary Care. Advise patient to purchase
  • Most bacterial infections are self-limiting. Mild cases should not need treating.
  • May be prescribed if appropriate to in-patients. 

 

Fusidic acid (Amber 1)

  • Viscous eye drops 1% (Contains: benzalkonium chloride, disodium edetate)  

 Notes:

  • Fusidic acid should be reserved for when chloramphenicol is not indicated or inappropriate.

 

 

Aminoglycosides

 

Gentamicin  

  • Preservative free eye drops 1.5%  U
  • Drops 0.3%

 

 

Cephalosporins

 

 Cefuroxime

  • Aprokam® Intracameral Injection, 50mg powder for solution for injection in vial plus filter needle

 

 

Macrolides

 

Ciprofloxacin (Amber 1)

  • Ophthalmic solution 0.3%
  • Eye ointment 0.3% 

Notes:

  • Ciprofloxacin eye drops should be reserved for treatment of corneal ulcers.

 

 

 

Ofloxacin

  • Ophthalmic solution 0.3% 

 

 

Erythromycin U

  • Eye ointment 0.5%

 

 

 

    

11.3.2 Viral infection 

 

Aciclovir  (Amber 2)

  • Eye ointment 3%          

Notes:

  • Aciclovir may be used for dendritic corneal ulcers caused by herpes simplex. It may also be used in shingles as an adjunct to full dose oral therapy where there is ophthalmic involvement

 

 

Ganciclovir  (Amber 2)

  • Virgan® Ophthalmic gel 0.15%   

 

 

 

 

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.

 

Return to Chapter: 11. Eye

Last updated by: Dupe Fagbenro on 05-12-2018 10:33