East Region Formulary

Prescribing Notes:

Drugs administered as eye drops penetrate directly into the globe through the cornea. Absorption may also occur into the general circulation via conjunctival vessels or from the nasal mucosa after drainage of excess preparation down through the tear ducts; this can produce systemic side effects. Systemic absorption can be reduced by ‘punctal occlusion’, i.e. pressing tightly with a finger on the inside corner of the eye for about half a minute after instilling the eye drop.
Eye drops should be instilled by pulling down the lower eyelid and putting one drop into the pocket that is formed. The eye should then be closed tightly for about a minute (or see ‘punctal occlusion’ above). The conjunctival fornix can only accommodate one drop. Any extra will overflow, possibly leading to systemic absorption, so only one drop should be used. Where applicable, the patient should leave an interval of at least a few minutes between administering two preparations.
Eye ointments may be applied to the inside of the lower eyelid when a prolonged action is required.
Eye ointments are applied by starting at the inside corner of the eye and squeezing a thin line (about half a centimetre) along the inside of the lower lid, then blinking the eye.
Subconjunctival injection may be used to administer anti-infective drugs, mydriatics or corticosteroids for conditions not responding to topical therapy.
If using different eye products, leave a period of about 5 minutes between applications. Instil ‘thinnest to thickest’ (i.e. aqueous drop, then suspension, then gel drop, then ointment last).
After using eye drops or eye ointment, patients should be advised not to drive or perform skilled tasks until vision is clear.
A preservative-free formulation may be prescribed, if available, for all formulary products if clinically necessary as an alternative option.
Eye-drop dispenser devices (Compleye, Opticare, Opticare Arthro 5, Opticare Arthro 10) are available to aid the instillation of eye drops from plastic bottles. They are particularly useful for those who may have dexterity issues.
Patients would not be expected to instil drops during the night unless specifically indicated.
If the preparation prescribed contains preservatives such as benzalkonium chloride, patients who wear soft contact lenses should be advised to stop wearing the lenses during treatment and for 48 hours afterwards. For further information see BNF or the product literature.
Unlicensed eye products should only be used when no licensed alternative eye products are considered suitable. Special order products tend to be significantly more expensive than licensed alternatives.
Patients should be advised that there is no strong evidence that vitamin supplements are beneficial in the majority of patients with eye conditions including dry macular degeneration and for this reason they cannot be prescribed.
Key advice to patients who smoke should be to stop smoking.
A healthy diet should be advised. If they wish, patients may purchase a suitable supplement preparation instead but they should seek advice from their pharmacist especially if they are smokers.

History Notes

15/06/2022

East Region Formulary content agreed.

Prescribing Notes:

Eye drops in multi-use containers for use in the community should be discarded 4 weeks after opening to avoid contamination, unless otherwise stated by the manufacturer.
Single dose units should be used once only and not re-used unless stated by the manufacturer. They should not be used for more than one patient. Preservative-free preparations may be single use only or discarded a set time after opening as per manufacturer’s instructions. Specially manufactured preservative-free eye drops usually keep for 1 week in the fridge after first opening. Newer commercially manufactured preservative-free drops can keep for longer depending on the particular manufacturer’s instructions.
It is not generally necessary to use separate bottles for each eye (except immediately after eye surgery), but care should be taken to avoid touching the eye(s) during use to avoid contamination. Most drops do not need to be kept in a fridge, unless directed otherwise. If an eye has an active infection – the bottle for that eye should be different to the fellow eye.
In the case of antibiotic eye drops, and other conditions such as glaucoma, patients should be counselled to continue treatment for the stated duration and not to stop using because the condition appears to have improved.

History Notes

15/06/2022

East Region Formulary content agreed.

Prescribing Notes:

Drugs administered as eye drops penetrate directly into the globe through the cornea. Absorption may also occur into the general circulation via conjunctival vessels or from the nasal mucosa after drainage of excess preparation down through the tear ducts; this can produce systemic side-effects. Systemic absorption can be reduced by ‘punctal occlusion’, i.e. pressing tightly with a finger on the inside corner of the eye for about half a minute after instilling the eye drop.
Eye drops should be instilled by pulling down the lower eyelid and putting one drop into the pocket that is formed. To do this, tilt the head back or lie the child down and direct the gaze of the child upwards. The eye should then be closed tightly for about a minute (or see ‘punctal occlusion’ above). If this method of instillation is not possible, lie the infant on their back, drop the solution into the corner, wait until the infant’s eyes open and then gently wipe away the excess. The conjunctival fornix can only accommodate one drop; since any extra will overflow (possibly leading to systemic absorption), only one drop should be used.
Eye ointments may be applied to the inside of the lower eyelid when a prolonged action is required.
Eye ointments are applied by starting at the inside corner of the eye and squeezing a thin line (about half a centimetre) along the inside of the lower lid, then blinking the eye. Alternatively, massage the ointment into the upper and lower conjunctival sacs with finger massage on the upper and lower lids.
Subconjunctival injection may be used to administer anti-infective drugs, mydriatics or corticosteroids for conditions not responding to topical therapy.
Contact lenses should not generally be worn while using eye drops containing preservatives, or eye ointments. further information see BNFc or the product literature.
If using 2 different eye drops, leave a period of about 5 minutes between the two drops. If using drops and ointment, use the drop first then wait 5 minutes before applying the ointment.

History Notes

29/07/2020

Content migrated from LJF website.

Prescribing Notes:

Eye drops in multi-use containers for use in the community should be discarded 4 weeks after opening to avoid contamination. Note: preservative-free preparations may be single-use only or to be discarded 1 week after opening. It is not generally necessary to use separate bottles for each eye (except immediately after eye surgery), but care should be taken to avoid touching the eye(s) during use to avoid contamination. Most drops do not need to be kept in a fridge, unless directed otherwise.

History Notes

29/07/2020

Content migrated from LJF website.