Administration of drugs to the eye

1. Eye drops and eye ointments are instilled into the pocket formed by gently pulling down the lower eyelid. For eye drops, one drop is all that is needed as long as instillation is successful. For eye ointments, a small amount is applied similarly; the ointment melts rapidly and blinking helps to spread it.

2. When two or more different drops are required at the same time of day, the patient should leave an interval of 5 minutes between drops to avoid dilution and overflow. Also to use ointment preparations 5 minutes after drops.

3. Certain preparations included within this chapter of the formulary are unlicensed and marked with *. These products will be ordered specially and are not stocked; therefore a delay in obtaining stocks may be incurred. These 'specials' may be supplied when clinical need for the individual patient demands, given no commercial alternative is available. Specials are often very costly.

Administration aids: Eye drop dispensers are available to aid the instillation of eye drops especially amongst the elderly, visually impaired, arthritic, or otherwise physically limited patients. They can be purchased from most community pharmacies or prescribed on FP10 prescription. Please refer to the Drug Tariff for details - Appliances: Eye Drops Dispensers.

Preservatives and sensitisers:

1. Long-term administration of preservative containing eye drops may cause ocular irritation.

2. RCHT Eye Unit offer the following recommendations for when to use preservative free treatments:

• the patient has a proven allergy to the preservative
• frequent use of the drops - six or more time a day (long-term use)
• the patient is wearing a soft contact lens or bandage lens at the time of instillation, on specialist advice
• after a corneal transplant in selected cases, depending on indication, and in cases where the cornea is compromised, on specialist advice

3. All Minims^® and other single use products are preservative free.

Subfoveal choroidal neovascularisation

1. Verteporfin is licensed for use in the photodynamic treatment of subfoveal choroidal neovascularisation associated with age-related macular degeneration or with pathological myopia. It is also licensed for occult subfoveal choroidal neovascularisation with disease progression.

2. NICE: Photodynamic therapy for wet age-related macular degeneration

3. NICE Ranibizumab for age related macular degeneration

Ocular diagnostic and peri-operative preparations and photodynamic treatment

1. Fluorescein sodium is the standard preparation to detect ocular lesions and foreign bodies.

2. Indocyanine green is included as an ophthalmic diagnostic agent for limited specified indications where it is either superior to fluorescein angiography or is used in addition to fluorescein angiography.

3. Rose Bengal eye drops are included as a diagnostic aid for dry eyes.

4. Voltarol^® Ophtha (diclofenac) is a NSAID eye drop indicated for intra-operative and post-operative use. It is only available as single dose eye drops. Very few patients require long term therapy, usually under the supervision of an Ophthalmologist.

5. Acular^® (ketorolac) is another NSAID eye drop with similar action to Voltarol^® Ophtha. It is available as preserved eye drops and is a fraction of the cost.

6. Potassium ascorbate and disodium edetate are included for the treatment of chemical burns.

7. Refer to chapter 4 for botulinum preparations.

Approved via Cornwall Area Prescribing Committee May 2019