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 Formulary Chapter 11: Eye - Full Chapter
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11.08.01  Expand sub section  Tear deficiency, ocular lubricants, and astringents
Carbomer 980 0.2%
(eye drops)
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First Choice
Green
1st Choice - Preserved ocular lubricant for Meibomian gland dysfunction/tear lipid abnormalities

In primary care prescribe: Clinitas Gel® 
Hypromellose 0.5%
(eye drops)
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First Choice
Green
1st Choice - Preserved ocular lubricant - for aqueous deficiency 
Sodium Hyaluronate 0.4% (Clinitas Multi®)
(ocular lubricant, preservative-free)
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First Choice
Green

1st Choice - Preservative- Free ocular lubricant


NOTE:
1. This product differs from Clinitas gel above.
2. Multidose bottle (10ml) (Clinitas Multi®) may be used for up to 3 months once opened.
3. Each single dose unit (Clinitas®SDU) is resealable and may be reused for up to 12 hours
4. For patients with uncomplicated simple dry eye only. In patients needing ocular lubricants following eye surgery or those with compromised eyes use single dose units and discard after single use.

 
Sodium Hyaluronate 0.4% (Clinitas®SDU)
(eye drops, preservative-free)
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First Choice
Green
1st Choice - Preservative- Free ocular lubricant
NOTE:
1. This product differs from Clinitas gel above.
2. Each unit is resealable and may be reused for up to 12 hours for patients with uncomplicated simple dry eye only. Not to be reused in patients needing ocular lubricants following eye surgery or with compromised eyes. 
Carmellose Sodium 1%
(eye drops, single use, preservative-free)
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Second Choice
Green
2nd Choice - Preservative-Free ocular lubricant 
   
Hydroxypropyl Guar  (e.g. Systane®)
(eye drops)
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Second Choice
Green
2nd Choice - Preserved ocular lubricant
Bottles to be discarded 28 days after opening in accordance with RPSGB and BNF advice
Licensed Medical Device 
   
Hydroxypropyl Guar (e.g. Systane®SDU)
(eye drops, single use, preservative-free)
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Third Choice
Green
3rd Choice - Preservative-Free ocular lubricant
Licensed Medical Device 
   
Acetylcysteine/Hypromellose 5%/0.35% (e.g. Ilube®)
(eye drops)
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Formulary
Green
 
   
Acetylcysteine 5%
(eye drops, preservative-free)
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Restricted Drug Restricted
Amber Recommended
unlicensedunlicensed - Low Risk
Restricted - In secondary care Phone Pharmacy to Order 
   
Balanced Salt Solution
(solution 15ml, 250ml, 500ml)
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Formulary
Red
 
   
Balanced Salt Solution Plus
(solution 500ml)
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Restricted Drug Restricted
Red
Restricted - for use by Consultant Ophthalmologist, Larry Benjamin and may be prescribed by other consultant ophthalmologists for patients deemed to be at risk. 
   
Carbomer 980 0.2% (e.g. Viscotears®)
(liquid gel)
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Formulary
Green
 
   
Carmellose Sodium 0.5%
(eye drops, single use, preservative-free)
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Formulary
Green
 
   
Carmellose Sodium 0.5% (e.g. Celluvisc®)
(eye drops, single use, preservative-free)
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Restricted Drug Restricted
Red
Celluvisc® brand restricted - for use by hospital ophthalmology team only for contact lens diagnostics. For all other indications generic product to be used. 
   
Hypromellose 0.3%, 10mL
(eye drops, preservative-free)
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Restricted Drug Restricted Note: eye drops expire one week after opening.

Not recommended in primary care use unit dose product (Minims) 
   
Hypromellose 0.32% (e.g. Artelac®)
(eye drops, single use, preservative-free)
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Restricted Drug Restricted
Green
Restricted - only for use if patient required preservative-free formulation 
   
Lacri-Lube®
(eye ointment)
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Formulary
Green
See Ocular Lubricants - Primary/ Secondary care Guideline (BHTCG 371FM)  
   
Paraffin Yellow Soft (Simple eye ointment)
(eye ointment)
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Formulary
Green
 
   
Polyvinyl Alchohol 1.4%
(eye drops)
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Formulary
Green
 
   
Sodium Chloride 0.9%
(solution)
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Formulary see Section 13.11.01 
   
Sodium Chloride 0.9%
(eye drops, single use, preservative -free)
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Formulary
Green
 
   
Sodium Chloride 5%
(eye drops)
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Restricted Drug Restricted
Amber Initiation
Restricted - to initiation by Ophthalmology team and continuation by GPs 
   
Sodium Chloride 5%
(eye drops, single use, preservative-free)
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Restricted Drug Restricted
Amber Initiation
Restricted - to initiation by Ophthalmology team and continuation by GPs 
   
Xailin Night®
(eye ointment)
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Formulary
Green
To be used whilst Lacri-Lube is unavailable. 
   
 ....
 Non Formulary Items
Acetylcysteine 10%
(eye drops, preservative-free)

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Non Formulary
Black
unlicensedunlicensed - Low Risk
 
Acetylcysteine20%
(eye drops)

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Non Formulary
Black
unlicensedunlicensed - Low Risk
 
Hydroxyethylcellulose  (e.g. Minims® Artificial Tears)

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Non Formulary
 
Hypromellose  (e.g. Isopto Alkaline®)

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Non Formulary
 
Hypromellose 0.3%
(eye drops, single use, preservative-free)

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Non Formulary
Black
unlicensedUnlicensed
 
Hypromellose 0.3% with Dextran 70 0.1%  (e.g. Tears naturale®)

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Non Formulary
 
Liquid Paraffin  (e.g. Lubi-Tears®)

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Non Formulary
 
Povidone  (Oculotect®)

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Non Formulary
 
Sodium Chloride 0.9% unit dose  (Minims® Saline)

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Non Formulary
 
Sodium Chloride 5%
(eye ointment)

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Non Formulary
Black
 
Sodium Hyaluronate  (Hylo-Tear®)

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Non Formulary
 
Sodium Hyaluronate  (Vismed® Gel)

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Non Formulary
 
Sodium Hyaluronate  (Vismed® multi)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Black

Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
Drugs which have been evaluated and rejected by the Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol(SCP). Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs)  

Amber Initiation

Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments
Require the first prescription to be written by the specialist  

Amber Recommended

Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:- The first prescription may be written by the GP after specialist recommendation.  

Green

Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the MVG and APC.  

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