Transcript Topical_Eye_Formulary_2015_V_1 (1)

Walsall Topical Eye Formulary 2015
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Instructions and acknowledgements
Dry Eyes
Allergic Conjunctivitis
Bacterial Conjunctivitis
Ingredients and preservatives
in eye drops
Preservatives in all eye
products
Alphabetical list of products and
properties
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References
Instructions
Introduction
These guidelines are intended to assist healthcare professionals diagnose and manage patients
with minor eye conditions in Walsall. They were produced by the Walsall Local Opthalmic
Committee Walsall Joint Medicines Management Committee (JMMC) August 2015.
These guidelines are based on the best available evidence but their application can always be
modified by professional judgement.
Acknowledgments
Many thanks to all of the health care professionals and patient representatives who have
inputted to and commented on the Topical Eye guidelines.
References:
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Eye Drops
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Bacterial Conjunctivitis
Antibacterials
Antibacterial
Formulation
Comment
First line of treatment
Chloramphenicol 0.5%
Or
Chloramphenicol 1%
Or
Fusidic Acid (Fucithalmic™)
used four times a day or less,
for superficial eye infection
Patient with sensitivity to
preservatives
Useful for staphylococcal
infections
Chloramphenicol 0.5% (Minims)
used four times a day or less,
for superficial eye infection
Single use product (Minims®)
available
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Allergic Conjunctivitis
Anti-allergy
Severity
Formulation
First line of
treatment
Sodium Cromoglicate 2%)
(Inhibits the release from sensitised mast
cells of mediators of the allergic reaction.)
For Acute
symptom
Dose
Adults and Children over 6 years (For the relief
and treatment of the eye symptoms of
hayfever)
Drops used four times a day or less
2% preservative free eye drops (Catacrom)
In hay fever, start using the products 2-3 weeks
before symptoms appear.
Lodoxamide 0.1% (Alomide)
(mast cell stabiliser)
•
Child 4–18 years (For the prevention, relief
and treatment of vernal conjunctivitis, giant
papillary conjunctivitis, and allergic-atopic
conjunctivitis)
Improvement of symptoms may
sometimes require, 4 times daily
treatment for up to 4 weeks
•
Adults and Children over 6 years: (For the
prevention, relief and treatment of allergic
conjunctivitis, including seasonal allergic
conjunctivitis, and vernal-kerato
conjunctivitis).
One drop into each eye twice daily,
increasing when necessary to four
times daily. In seasonal allergic
conjunctivitis therapy should be
restricted to 12 weeks.
In vernal kerato-conjunctivitis: one
drop into each eye four times daily.
Olapatadine 1mg/ml eye drops
•
Used in paediatric patients three years of
age and older at the same dose as in adults.
(For relied and treatment of Seasonal allergic
and perennial conjunctivitis)
Twice daily (8 hourly). Treatment may
be maintained for up to four months. If
considered necessary.
Antazoline sulphate 0.5% + xylometazoline
0.05% eye drops
(Otravine-Antistin)
• Adults and children over 12 years of age.
(Temporary relief of symptoms of seasonal and
perennial allergies).
Dual action
Adults 1 or 2 drops instilled 2-3 times a
day. Elderly 1 drop instilled 2-3 times a
day. Should not be used for more than
seven days.
Nedocromil sodium 2%
(Rapitil) (prevent the release of
inflammatory mediators from a range of
inflammatory cell types)
(Long acting vasoconstrictor and H1
receptor antagonist)
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Dry Eyes
Dry Eyes
Severity
First Choice
Second Choice
Other/Third Choice
Mild dry eyes
(less than 4 drops
per day needed)
Hypromellose drops 0.5% or 0.3%
(interchangeable)
10ml
Carbomer 980 gel 10g (Clinitas™ gel)
Clinitas Hydrate 10g
Drops used four times a day or less
Optive™ 10ml (Carmellose) –multidose ∆⑥∞
Bed time :
Xailin night™ 5g or Vita-POS
Minimal damage to
conjunctiva and cornea
Or less if there is some
corneal and
conjunctival damage
Moderate dry
eyes (4 to 6
drops per day
needed)
More than 3rd of
damage to conjunctiva
and corneal damage.
Drops used more than four times a day
Carmellose1% unit doses (Pack 30) ∆∞, if not
tolerated, carmellose 0.5% (Xailin Fresh™) ∆∞
Evaporative, Meibomian gland dysfunction
Systane balance™(helps with lipid layer)
Hypromellose drops 0.5% or 0.3%
(interchangeable)
Carbomer 980 gel ,10g (Clinitas™gel)
A preservative free drop may be given if
drops are used
6 times a day
Hylo-Tear™ 0.1%∆⑥∞
or Clinitas multi (0.4%)
Drops used four times a day or less
Optive™ 10ml (Carmellose)-multidose ∆⑥∞
Bed time :
Xailin night ™ 5g
Drops used more than four times a day
Carmellose 1% unit doses (Pack 30) ∆∞, if not
tolerated, carmellose 0.5% (Xailin Fresh™) ∆∞
Hylo-forte 0.20% ∆⑥∞
OR
Lacrilube or Vita-POS™ (6
month expiry)
OR
Duolube™ 3.5g
Evaporative
Systane™ up to 4 times a day
Severe dry eyes
(more than 6
drops per day
needed)
Hylo-forte™ 0.20% drops 10ml multidoseΔ⑥ ∞
Carmellose 1% unit doses (Pack 30) ∆∞, if not
tolerated, carmellose 0.5% (Xailin Fresh™) ∆∞
Bed time :
Xailin night™ 5g
OR
Lacrilube or Vita-POS™ (6
month expiry)
Duolube 3.5g
Optive™ 10ml (Carmellose) – multidose ∆
⑥∞
Severe corneal and
Sodium hyalurnate 0.4% Clinitas multi is
Evaporative
conjunctival damage.
available for restricted use for short-term
Systane Ultra™
use in patients with non-healing
epithelial corneal ulceration/defects and
patients with severe dry eye syndrome.
Please note it is ONLY more cost-effective to start with a preparation with a 6 month expiry if patient uses it less than four times a day.
∆– Preservative free; ⑥- 6 month expiry once opened; ∞ suitable for use with contact lenses
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Ingredients and preservatives in eye drops
Ingredients
Hypromellose is a widely used product, and can be administered frequently. Products containing carbomers or polyvinyl
alcohol are longer-acting. Sodium Hyaluronate is becoming more widely used because of its water-retaining properties
and low resistance to blinking (viscoelastic property).
An evaluation by Guillion and colleagues found that dry eye suffers presenting with corneal or conjunctival staining, the
artificial tears featuring a polymeric lubricant (CMC or sodium hyaluornate) improved the health of ocular surface tissue
status.
Eye ointments containing paraffin may be uncomfortable and blur vision, they should only be used at night and never
with contact lenses, there are some alternatives available
Preservative toxicity from eye drops.
Benzalkonium chloride (BAK) is the most frequently used preservative in topical ophthalmic preparations, as well as in
topical lubricants. Its epithelial toxic effects are well established. The toxicity of BAK is related to its concentration,
frequency of use, the level or amount of tear secretion, and the severity of the ocular surface disease.
For patients with moderate to severe dry eye disease, the absence of preservatives is of more critical importance than
the particular polymeric agent used in ocular lubricants. The ocular surface inflammation associated with dry eye is
exacerbated by preserved lubricants and, if patients have more than one eye condition for which they are using eye
drops, their potential exposure to preservatives is increased.
Preservative-free formulations are absolutely necessary for patients with severe dry eye with ocular surface disease and
impairment of lacrimal gland secretion, or for patients on multiple, preserved topical medications for chronic eye
disease.
In a patient with mild dry eye, preserved drops are often well tolerated when used 4-6 times a day or less.
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References
References
• Behrens A, Doyle JJ, Stern L et al. Dysfunctional tear syndrome, A Delphi approach to treatment
recommendations. Cornea 2006 25:900-7
• Management and therapy of dry eye disease: Report of the management and therapy subcommittee of
the international dry eye workshop (2007). Ocul Surf 2007;5(2): 163-178.
• Ophthalmology Referral Guidelines, Oxfordshire PCT, March 2012
• The Eye Journal: Apr/May 2011: Dry Eye Syndrome: more attention needed to Identify and treat dry eye
syndrome by R Mcneil
• An Overview of the Issues Limiting Effective Management of the dry eye Syndrome in the UK; The Eye
Journal Aug/Sep 2010 by J Bleninsopp, C Chakrabory,FDR HoBBS et al.
• Clinical Knowledge Summaries http://www.cks.nhs.uk/dry_eye_syndrome#-320107
• The preferred practice pattern. Dry Eye Syndrome. The American Academy of Ophthalmology. Ltd
Revision October 2011 http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=127dbdce4271- 471a-b6d9-464b9d15b748
• 2007 report of the International Dry Eye Workshop (DEWS). The Ocular Surface April 2007: 5 (2).
http://www.tearfilm.org/dewsreport/pdfs/TOS-0502-DEWS-noAds.pdf
• NICE Clinical Knowledge Summaries Sept 2012. Dry Eye Syndrome. http://cks.nice.org.uk/dry-eyesyndrome#%21prescribinginfosub:1
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Alphabetical List of Dry Eye Approved Products
Product
Strength/Form
∆– Preservative free
Expiry once
opened
∞ suitable for use with contact
lenses
Carmellose
10ml 0.5% & 1% eye
drops
No
28 days
No
Carmellose
0.5% & 1% 30 x 0.4ml
UDVs
Yes
Single use
Yes
Clinitas Gel™
Carbomer 980 gel
10g 0.2% gel
Yes
28 days
Remove lenses apply-wait 30 mins.
then re-insert lens
Clinitas hydrate
10g 0.2% gel
No
28 days
Clinitas Multi™
Sodium hyaluronate
10ml 0.4% eye drops
Yes
3 months
Yes
Duolube™
3.5g ointment
Yes
28 days
No
Hylo Tear
Hylo Forte™
1%
2%
Yes
6 months
Yes
Hypromellose eye drops
O.5 or 0.3%
No
28 days
Lacrilube™
5g ointment
Yes
28 days
Remove lenses apply-wait 30 mins.
then re-insert lens
Optive™
Carmellose/glycerol multidose
10ml
No
6 months
Yes
Systane™
10ml gel drops
No
28 days
No
Systane Balance™
10ml eye drops
No
28 days
No
Systane Ultra™
10ml eye drops
No
28 days
No
Vita Pos™
5g ointment
Yes
6 months
Remove lenses apply-wait 30 mins.
then re-insert lens
Xailin Fresh
(Carmellose sodium)
0.5% 30 x 0.4ml UDV
drops
Yes
Single use
Yes
Xailin Night™
5g ointment
Yes
28 days
Remove lenses apply-wait 30 mins.
then re-insert lens
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Alphabetical List of Other Approved Products
Product
Strength/Form
∆– Preservative free
Expiry once
opened
∞ suitable for use with contact
lenses
Alomide™
Lodoxamide
5ml 0.1% eye drops
No
28 days
No
Chloramphenicol
10ml 0.5% eye drops
No
28 days
Not to be worn during treatment
Catacrom™
Sodium Cromoglicate
2% 0.3ml UDV
Yes
Single use
Yes
Chloramphenicol
0.5% (Minims) 0.5ml
UDV
Yes
Single use
Not to be worn during treatment
Chloramphenicol
1% eye ointment 4g
28 days
Not to be worn during treatment
Fucithalmic™
Fusidic Acid
1% viscous eye drops
No
28 days
Not to be worn during treatment
Olapatadine
1mg/ml eye drops
No
28 days
No
Otrivine-Antistin™
Antazoline sulphate xylometazoline
0.5% + 0.05% eye drops
No
28 days
No
Rapitil™
Nedocromil sodium
2% eye drops
No
28 days
Remove and wait 15 mins. before
reinsertion
Sodium Cromoglicate
2% eye drops
No
28 days
Remove and wait 15 mins. before
reinsertion
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