Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
11.8 Miscellaneous ophthalmic preparations
Dry eyes:Hypromellose 0.3% drops £1.21 (10ml)
0.5% drops: £0.81 (10ml)
1% drops: £0.94 (10ml)
Treatment for dry eyes associated with tear deficiency should normally commence with the least viscous agent e.g. Hypromellose 0.3% drops and work through alternatives in increasing order of viscosity.
Preservative-free
as Evolve Hypromellose®
0.3% drops: £1.98 (10ml)
Treatment for dry eyes associated with tear deficiency in patients who have sensitivity to benzalkonium chloride. Drops last 3 months from first opening. Suggest patients writes date of opening and expiry inside lid of box.

Dry Eye 

Refer for same-day specialist assessment if acute glaucoma, keratitis, or iritis is suspected because of:
Moderate-to-severe eye pain or photophobia.
Marked redness of the eye in one eye (consider Optometry Red Eye Service)
Reduced visual acuity.

Management of Dry Eye Syndrome in Primary Care

The condition cannot be cured but symptoms may be relieved and deterioration stopped by simple tear-replacement treatment.

Self-care options may be sufficient to avoid the need for treatment.

  • Eyelid hygiene to control the blepharitis that most people with dry eye syndrome have.
  • Limiting the use of contact lenses, if these cause irritation.
  • Stopping medication that exacerbates dry eyes, such as topical and systemic antihistamines.
  • Using a humidifier to moisten ambient air.
  • If smoking tobacco, stopping smoking may help
  • If using a computer for long periods, ensure that the monitor is at or below eye level, avoid staring at the screen, and take frequent breaks to close/blink eyes.
  • Consider the effects of other medications, e.g Preservatives in topical eye medications, antihistamines, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs)
  • Consider underlying medical and surgical conditions associated with dry eye syndrome, for example: allergic conjunctivitis, Sjögren’s syndrome, facial or trigeminal neuropathy, herpes zoster affecting the eye, chronic dermatoses of eyelids, previous ocular or eyelid surgery, trauma, radiation therapy, burns.

If there is an underlying condition (suspected or known) that can cause dry eyes, consider referral for specialist assessment if that condition is not normally managed in primary care

Treatment Options

Mild symptoms

Dry eye symptoms can usually be managed satisfactorily with lubricant and lipid tear supplement eye drops and lifestyle changes.

Moderate symptoms

Patients may require more frequent use of tear supplements and/or use of a more viscous product.
Symptoms may include some degree of blurred vision and sensitivity to light and could result in restricted activities.

Product Type Preservative content Cost Formulary Choices
First line options for mild to moderate symptoms
Hypromellose Contain preservatives £1.40

£0.81

Hypromellose 0.3% 10ml or

Hypromellose 0.5% 10ml as Isopto Plain TM

  Preservative- free £1.98 Evolve Hypromellose 0.3% preservative-free 1 x10ml
Second line options
Carbomer Contain preservatives £1.49 Clinitas Carbomer gel 1x10g
  Preservative-free £5.42 Viscotears Carbomer 0.2% (30 x 0.6ml unit dose)
Sodium Hyaluronate Contain preservatives £2.97 Blink Intensive Tears 0.2% 1x10ml
  Preservative-free £5.99

 

£5.37

INFREQUENT USE: Evolve HA (sodium hyaluronate 0.2%) 1x10ml

 

FREQUENT USE : Ocusan 0.2% (20x 0.5ml resealable single use drops each containing 12 drops)

Carmellose Evolve carmellose  is preservative free but is cost-effective option for all  

£4.99

(Use for up to 90 days)

Evolve Carmellose 0.5% 1x10ml
Preservative-free £4.99

(Use for up to 90 days)

 

INFREQUENT USE: Evolve Carmellose 0.5% 1x10ml
(250 drops)
Polyvinyl alcohol Contain preservatives £1.06 Snotears 1.4% 1x10ml
Preservative-free £2.25 Refresh Ophthalmic 1.4% 30×0.4ml
Propylene Glycol Contain preservatives £4.66

£6.69

Systane 0.2% 1x10ml

Systane Ultra

  Preservative-free £4.66

£6.69

Systane preservative-free single unit doses (28)

Systane Ultra preservative-free single unit doses (30)

Liquid paraffin Contain preservatives

Preservative-free

£3.98

 

£2.51

Lacrilube 5g

Xailin Night 5g preservative free
(note – more cost effective than Lacrilube)

Acetylcisteine Contain preservatives £14.93 Ilube 5% 1 x 10ml
In general preservative-free formulations are more expensive so limit to cases where:

·         previously known sensitivity to eye drop preservatives such as benzalkonium chloride

·         severe symptoms require eye drops  to be applied more than six times a day after 4 weeks – there is increased risk of irritation from the preservatives as use increases

·         if soft contact lenses worn

·         or on the advice of a specialist