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11.4 Eye Procedures

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.

 

 

11.4 Eye Procedures

Antimuscarinics

 

Atropine sulphate

  • Eye drops 1% Contains: benzalkonium chloride (Amber 1)  
  • Minims® Single use eye drops 1% (Amber 3)  

Notes:

  • Atropine Minims® single use eye drops are also recommended for sublingual use in patients with sialorrhea in Parkinson’s Disease; Consultant neurologist initiation and stabilisation only.

 

 

Cyclopentolate hydrochloride  (Amber 2)

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

 

 

 

Tropicamide

  • Minims® Single use eye drops 0.5%, 1%       

Notes:

  • Antimuscarinics dilate the pupil and relax the ciliary muscle resulting in mydriasis and cycloplegia.
  • They can raise Intra Ocular Pressure (IOP) and should be used with caution in those patients susceptible to angle closure.
  • Tropicamide activity is approximately 4-6 hours and makes it ideal for mydriasis prior to ophthalmological examination.  

 

 

 

Iodine Products and products for ocular peri-operative irrigation 

  

Acetylcholine chloride

  • Injection 1%       

 

Disodium edetate - EDTA U

  • Solution 0.37%     

 

Mydricaine  U

  • Formula 1
  • Formula 2                

 

Povidone Iodine 

  • Single Use Eye Drops Minims® 5%

Notes: 

  • Antiseptic prior to surgical procedures post-Trabeculectomy

 

 

Visco-elastic drugs  

Sodium Hyaluronate

  • Intraocular Injection 5mg/0.5mL 

 

 

Ocular Diagnostic agents - Dyes

Fluorescein sodium

  • Single use eye drops 2%
  • Ophthalmic strip
  • Injection 20% (unlicensed)

Notes:

  • Fluorescein sodium is the standard preparation to detect ocular lesions and foreign bodies.
  • It is used in both primary and secondary care clinic settings and it should not be prescribed for patients as it is used for diagnostic purposes only.

 

Rose Bengal

  • Minims®, Single use eye drops 1%

 

Miotics

 

Acetylcholine chloride

  • Injection 1% 

 

 

Sympathomimetics

 

Adrenaline  U 

  • Eye drops; adrenaline 0.01% 

Note: 

  • To constrict vessels during Trabeculectomy surgery and reduce intraocular bleeding

 

Phenylephrine hydrochloride  (Amber 2)

  • Minims® Single use eye drops 2.5%, 10%    

Notes:

  • Phenylephrine hydrochloride is used for mydriasis in diagnostic procedures and pre-operative use

 

Phenylephrine hydrochloride with tropicamide

  • Mydriasert® Ophthalmic insert, phenylephrine hydrochloride 5.4mg, tropicamide 280mcg

Notes:

  • Patients with severe dry eyes may require a drop of saline to improve insert tolerance.

 

 

 

 

11.4.1 Post operative pain and inflammation

 

Anaesthetics,Local

 

Lidocaine Hydrochloride 4% with Fluorescein 0.25%

  • Minims® Eye drops, single use, preservative-free

Notes: 

  • Ophthalmic Consultant use only
  • Local anaesthetic and staining

 

Oxybuprocaine Hydrochloride

  • Single use eye drops 0.4%
  • For neonatal use only

 

Proxymetacaine

  • Single use eye drops 0.5%

 

 

Analgesics, Non-steroidal anti-inflammatory drugs

 

Flurbiprofen  (Amber 2)

  • Ophthalmic solution 0.03%

 

Ketorolac  (Amber 2)

  • Eye drops 0.5% (Contains: benzalkonium chloride, disodium edetate)

 

 

Corticosteroids

 

Loteprednol etabonate

  • Eye drops: Loteprednol etabonate 0.5%

Notes:

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

 

 

 

Emergency use

Sodium Citrate  U

  • Eye drops 10.11% (equivalent to citrate 6.5%)

Indication: Acid & alkali burns to the cornea

 

Phosphate Buffer  U  (Amber 2)   

  • Solution

 

 

 

 

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: Sheila Wood on 18-10-2018 13:05