Dry eyes

Prescribing Notes:

• All lubricating eye drops and ointments are available to buy over-the-counter.
• Most lubricant eye drops can be prescribed generically.
• Chronic soreness of the eyes due to reduced / abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
• Hypromellose eye drops have always been the traditional choice of treatment for tear deficiency. They are the cheapest and the least viscous and may need to be instilled frequently to get relief.
• Frequent instillation of preserved drops (e.g. hourly / 2-hourly) may cause a sensitivity reaction to the preservative in the drops. Patients using lubricants more than 6 times per day should use preservative-free preparations in order to avoid toxicity from high levels of preservative.
• Carbomer does not contain benzalkonium chloride and therefore may be suitable for use in patients who are allergic to preservatives. Most eye drops contain benzalkonium chloride as a preservative therefore this is what most people mean when they say they are ‘allergic to preservatives’.
• Preserved eye drops are less expensive than preservative-free. Preservative-free eye drops in multi-dose bottles are less expensive than single dose units.
• Xailin Night is a paraffin-based eye ointment. It contains lanolin but is preservative free. It is usually used at night but can be used during the day in cases of persistent corneal erosion but will blur the vision. Eye ointments may be used to lubricate the eye surface, especially in cases of recurrent epithelial erosion. However, because they can cause temporary visual disturbances, they should normally be applied before sleep.
• HydraMed Night Sensitive is a lanolin-free lubricating eye ointment. It is not available to prescribe, but patients may be advised that it is available to buy over-the-counter.
• A range of different products are available to treat dry eyes. The severity of tear deficiency, cost and patient preference will often guide the choice of preparation.
• Various products containing carbomers, carmellose and sodium hyaluronate are available.

Prescribing Notes:

• All lubricating eye drops and ointments are available to buy over-the-counter.
• Most lubricant eye drops can be prescribed generically. There are many different sodium hyaluronate products available, generic prescribing is considered appropriate for most individuals. If you choose to prescribe a specific product for a clinical reason, (e.g. dexterity issues or sensitivities to excipients) it is recommended that a brand name is used and clinical reason is documented in patient correspondence and on the patient PMR. There may be an additional cost impact to consider. Part 3 of the Scottish Drug Tariff contains details on generic preparations. 
• Chronic soreness of the eyes due to reduced / abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
• Frequent instillation of preserved drops (e.g. hourly / 2-hourly) may cause a sensitivity reaction to the preservative in the drops. Patients using lubricants more than 6 times per day should use preservative-free preparations in order to avoid toxicity from high levels of preservative.
• Carbomer does not contain benzalkonium chloride and therefore may be suitable for use in patients who are allergic to preservatives. Most eye drops contain benzalkonium chloride as a preservative therefore this is what most people mean when they say they are ‘allergic to preservatives’.
• Preservative free drops are recommended for patients with moderate to severe dry eyes due to the increased frequency of administration.
• Preserved eye drops are less expensive than preservative-free. Preservative-free eye drops in multi-dose bottles are less expensive than single dose units.
• A range of different products are available to treat dry eyes. The severity of tear deficiency, cost and patient preference will often guide the choice of preparation.
• Various products containing carbomers, carmellose and sodium hyaluronate are available.
• Products containing carmellose, sodium hyaluronate and polyethylene glycol are reserved for patients with moderate-severe dry eyes where 1st and 2nd choice products have been ineffective. Patients should be informed that this product will produce a stinging sensation on instillation into the eye.

Prescribing Notes:

• All lubricating eye drops and ointments are available to buy over-the-counter.
• Most lubricant eye drops can be prescribed generically. There are many different sodium hyaluronate products available, generic prescribing is considered appropriate for most individuals.  If you choose to prescribe a specific product for a clinical reason, (e.g. dexterity issues or sensitivities to excipients) it is recommended that a brand name is used and clinical reason is documented in patient correspondence and on the patient PMR. There may be an additional cost impact to consider. Part 3 of the Scottish Drug Tariff contains details of generic preparations. 
• Chronic soreness of the eyes due to reduced / abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
• Frequent instillation of preserved drops (e.g. hourly / 2-hourly) may cause a sensitivity reaction to the preservative in the drops.
• Preservative free drops are recommended for patients with moderate to severe dry eyes due to the increased frequency of administration.
• Preserved eye drops are less expensive than preservative-free. Preservative-free eye drops in multi-dose bottles are less expensive than single dose units.
• Ciclosporin 1mg/ml drops (Ikervis) may be initiated by specialist hospital consultant for severe dry eyes with inflammatory component. They are approved for restricted use, initiated by a specialist, for the treatment of severe keratitis in adult patients who have not responded adequately to tear substitutes. Use under specialist advice only for any increase in frequency.
• Acetylcysteine drops may be initiated by specialists in ophthalmology for severe dry eyes. They are approved for restricted use, initiated by a specialist, for the treatment of impaired or abnormal mucus production in patients who have not responded adequately to tear substitutes. Use under specialist advice only for any increase in frequency. Acetylcysteine drops are useful as a mucolytic in dry eyes associated with filamentary keratitis.

Prescribing Notes:

• Mild dry eye symptoms are not something that children generally complain of. They most commonly get dry eyes as a symptom of another disease, in which case a more viscous preparation is required. Opthalmologists will generally choose from moderate to severe category choices when treating these children.
• All lubricating eye drops and ointments are available to buy over-the-counter.
• Eye drops can be prescribed generically. Currently the most cost effective branded preparations are Clinitas gel (carbomer 0.2%), Cellusan Light (carmellose 0.5%) and Cellusan (carmellose 1%).
• Chronic soreness of the eyes due to reduced/abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
• Hypromellose eye drops is the traditional choice of treatment for tear deficiency. It is the cheapest and the least viscous.
• Frequent instillation of preserved drops (e.g. hourly hypromellose) may cause a sensitivity reaction to the preservative in the drops.
• Carbomer does not contain benzalkonium chloride and therefore may be suitable for use in patients who are allergic to preservatives.
• Preservative free drops are recommended for patients with moderate to severe dry eyes due to the increased frequency of administration.
• Multidose bottles are less expensive for regular use than single dose vials.

Prescribing Notes:

• Mild dry eye symptoms are not something that children generally complain of. They most commonly get dry eyes as a symptom of another disease, in which case a more viscous preparation is required. Opthalmologists will generally choose from moderate to severe category choices when treating these children.
• All lubricating eye drops and ointments are available to buy over-the-counter.
• Eye drops can be prescribed generically. Currently the most cost effective branded preparations are Clinitas gel (carbomer 0.2%), Cellusan Light (carmellose 0.5%) and Cellusan (carmellose 1%).
• There are many different sodium hyaluronate products available. In order to avoid confusion, it is recommended that Vismed is prescribed by brand name.
• Chronic soreness of the eyes due to reduced/abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
• Frequent instillation of preserved drops (e.g. hourly hypromellose) may cause a sensitivity reaction to the preservative in the drops.
• Carbomer does not contain benzalkonium chloride and therefore may be suitable for use in patients who are allergic to preservatives.
• Preservative free drops are recommended for patients with moderate to severe dry eyes due to the increased frequency of administration.
• Multidose bottles are less expensive for regular use than single dose vials.

Prescribing Notes:

• Mild dry eye symptoms are not something that children generally complain of. They most commonly get dry eyes as a symptom of another disease, in which case a more viscous preparation is required. Opthalmologists will generally choose from moderate to severe category choices when treating these children.
• All lubricating eye drops and ointments are available to buy over-the-counter.
• Eye drops can be prescribed generically. Currently the most cost effective branded preparations are Clinitas gel (carbomer 0.2%), Cellusan Light (carmellose 0.5%) and Cellusan (carmellose 1%).
• There are many different sodium hyaluronate products available. In order to avoid confusion, it is recommended that Hylo-Forte is prescribed by brand name.
• Chronic soreness of the eyes due to reduced/abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
• Frequent instillation of preserved drops (e.g. hourly hypromellose) may cause a sensitivity reaction to the preservative in the drops.
• Carbomer does not contain benzalkonium chloride and therefore may be suitable for use in patients who are allergic to preservatives.
• Preservative free drops are recommended for patients with moderate to severe dry eyes due to the increased frequency of administration.
• Multidose bottles are less expensive for regular use than single dose vials.
• Acetylcysteine drops may be initiated by specialist in ophthalmology for severe dry eyes. They are approved for restricted use, initiated by a specialist, for the treatment of impaired or abnormal mucus production  in patients who have not responded adequately to tear substitutes. Use under specialist advice only for any increase in frequency. Acetylcysteine drops are useful as a mucolytic in dry eyes associated with filamentary keratitis.

Prescribing Notes:

• The severity of the condition and patient preference will often guide the choice of preparation.
• Most cases of sore tired eyes resolve themselves.
• Chronic soreness of the eyes due to reduced/abnormal tear secretion often responds to tear replacement therapy.
• Particular care should be taken with patients who wear contact lenses to ensure the product given is suitable.
• Frequent installation of drops e.g. hourly may cause a sensitivity reaction to the preservative in the eye drops. Preservative–free (P/F) formulations are recommended in patients who frequently use eye drops (>6 times per day).

When to advise patient to contact GP/ Optometrist
If condition lasts longer than 2 weeks.
Pain or signs of infection i.e. purulent discharge.