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.

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.

 

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
11.8 Miscellaneous ophthalmic preparations
Dry eyes:
First line option for mild to moderate symptoms Hypromellose
0.3% drops

0.5% drops
as Isopto Plain®
0.3% drops £1.21 (10ml)

0.5% drops: £0.81 (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.
Hypromellose 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.
Second line optionsCarbomer
as Clinitas Carbomer gel®
0.2% gel: £1.49 (10g)
Carbomer Preservative-free
as Viscotears Single Dose®
0.2% gel: £5.42 (30x0.6ml)
Sodium Hyaluronate
as Blink Intensive Tears®
0.2% drops: £2.97 (10ml) 28 day expiry.
Sodium Hyaluronate Preservative-free

For infrequent use
as Evolve HA®

For frequent use
as Ocusan®


0.2% drops: £5.99 (10ml)


0.2% drops: £5.37 (20x0.5ml)


Infrequent use: Evolve HA - Use for up to 90 days


Frequent use: Ocusan - 20x0.5ml resealable single use drop each containing 12 drops.
Carmellose Preservative-free
as Evolve Carmellose®
0.5% drops: £4.99 (10ml - 250 drops)Infrequent use - Use for up to 90 days. Evolve Carmellose is preservative-free but is cost effective option for all.
Polyvinyl alcohol
as Sno Tears®
1.4% drops: £1.06 (10ml)
Polyvinyl alcohol Preservative-free
as Refresh Opthalmic®
1.4% drops: £2.25 (30x0.4ml)
Propylene Glycol
as Systane®

as Systane Ultra®
0.3% drops: £4.66 (10ml)

0.3% drops: £6.69 (10ml)
Propylene Glycol Preservative-free
as Systane®

as Systane Ultra®
0.3% P/F single use drops: £4.66 (28x0.8ml)

0.3% P/F single use drops: £6.69 (30x0.7ml)
Liquid paraffin Preservative-free
as Xailin Night®
ointment: £2.51 (5g)
Acetylcisteine
as Ilube®
5% drops: £16.90 (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
For patients who find administration of eye drops difficult we recommend prescription of these devices
Opticare (for 2.5, 5, 10, 15 & 20ml bottles) £4.95
Opticare Arthro 5 (for 2.5 & 5ml bottles) £4.95
Opticare Arthro 10 (for 10, 15, 20ml bottles) £4.95