Lancashire and South Cumbria Formulary

Formulary Chapter 11: Eye - Full Chapter

Chapter Links...

NICE NG242: Diabetic retinopathy: management and monitoring

NICE NG77: Cataracts in adults: management

NICE NG81: Glaucoma: diagnosis and management

NICE NG82: Age-related macular degeneration

Details...

11.01

Administration of drugs to the eye

The Drug Tariff only lists the five eye drop dispensers below:

ComplEye, EyGuide, Opticare, Opticare Arthro 5, Opticare Arthro 10

Other products cannot be prescribed on NHS FP10 prescriptions. Eye drop dispensers are classed as medical appliances and therefore must be included in Part IXA of the Drug Tariff to be allowable on an NHS prescription. Other eye drops dispensers are available, but cannot be prescribed on NHS prescriptions. When recommending eye drop dispensers it is important to ensure that the eye drops and the eye drop dispenser are compatible. They are particularly useful for the elderly, visually impaired, arthritic, or otherwise physically limited patients.

See BNF for general guide on administration of drugs to the eye
https://bnf.nice.org.uk/treatment-summaries/eye/

11.02

Control of microbial contamination

11.03

Anti-infective eye preparations

11.03.01

Antibacterials

A course length should always be indicated on the prescription.

11.03.02

Antifungals

11.03.03

Antivirals

11.04

Corticosteroids and other anti-inflammatory preparations

11.04.01

Corticosteroids

Topical corticosteroids should normally only be used under expert supervision

11.04.02

Other anti-inflammatory preparations

11.05

Mydriatics and cycloplegics

11.05

Antimuscarinics

11.05

Sympathomimetics

11.06

Treatment of glaucoma

Treatment for glaucoma should be initiated by a consultant or specialist in ophthalmology, repeat prescriptions however should be provided in primary care.

11.06

Beta-blockers

CSM advice: Beta-blockers, even those with cardioselectivity should be avoided in patients with asthma or a history of COPD unless no other alternative treatment is available - see BNF

11.06

Prostaglandin analogues

11.06

Sympathomimetics

11.06

Carbonic anhydrase inhibitors and systemic drugs

11.06

Miotics

11.06

Prostaglandin and Rho Kinase Inhibitor dual therapy

11.07

Local anaesthetics

Used before surgery on the eye. Not to be used for the management of ocular symptoms.

11.08

Miscellaneous ophthalmic preparations

11.08.01

Tear deficiency, ocular lubricants, and astringents

Ocular lubricants under normal circumstances should be purchased OTC.

11.08.02

Ocular diagnostic and peri-operative preparations and photodynamic treatment

11.08.02

Ocular diagnostic preparations

11.08.02

Ocular peri-operative drugs

11.08.02

Subfoveal choroidal neovascularisation

11.08.02

Vitreomacular traction

11.08.02

Uveitis

11.08.03

Reduction of elevated intra-ocular pressure

11.09

Contact lenses

See BNF

11.10

Additional treatments used in the management of ophthalmic conditions not listed in BNF chapter 11

11.11

Miscellaneous

11.11

Antifungals

11.11

Cytotoxics / wound healing modulators

11.11

Fibrinolytic drugs

11.11

Glues - ocular

11.11

Immunosuppressants

11.11

Treatment of burns

11.11

Visco-elastics

11.11

Other

....

Key

	Restricted Drug
	Unlicensed
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium
	Cytotoxic Drug
	Controlled Drug

	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	ICB
	Low carbon footprint
	Medium carbon footprint
	High carbon footprint

Status	Description
	Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.
	Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.
	Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.
	Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.
	Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.
	Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).
	Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.
	Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.
	Refer to local guidance.

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/