Download Dry eyes education information leaflet

Ocular Lubricant Prescribing Guidelines
This document is intended to guide the choice of first and subsequent line therapy for patients
requiring ocular lubricants, taking account of patient choice and any allergies to preservatives etc.
It is important that patients are happy with the choice of their ocular lubricant and are able to use it
effectively in order to gain maximum benefits.
Considerations before prescribing
 Dry eyes is a common problem, with prevalence in the >65yrs is reported as between 1533% and increases with age. Women are typically affected more than men
 Prognosis depends on underlying causes but generally most patients with dry eyes only have
discomfort without loss of vision but rarely the corneal ulcers can develop.
 Consider Precipitating factors before prescribing ocular lubricants, including; allergy,
infection, blepharitis, medication (e.g. diuretics, drugs with anticholinergic effects, β-blockers)
and environmental factors. Long sessions of reading, TV watching and computer use reduce
blink rate and exacerbate the problem.
 Ocular lubricants should be prescribed by BRAND where stated to ensure the most cost
effective preparations are used.
 Each type of eye drop should be prescribed for 4-6 weeks before a different type is
prescribed.
 Patients should be asked what products (if any) they have already tried and for how long they
have used them so that suitable alternatives can be tried next.
 If a patient needs to use hypromellose 0.3% or polyvinyl alcohol (PVA)] eye drops more
frequently than 4 times daily, a more viscous lubricating eye drop should be prescribed.
 If a patient needs to use Carbomer 980 more frequently than 3 times daily, a third line
lubricating eye drop should be prescribed.
 If a patient has tried 3 different types of eye lubricants or third line options and continues to
have symptoms of dry eye the patient should be considered for referral.
 Some patients may develop sensitivities to preservatives and if confirmed, the name must be
documented so that any future products used do not contain this preservative. Preservativefree preparations should only be considered where;
 the patient has a documented allergy or evidence of epithelial toxicity to the preservatives
contained in a preparation
 the patient needs to use more than 4-6 applications of eye drops containing preservative
a day and the next line lubricating choices are not appropriate
 Immediately following eye surgery, until healing is confirmed
 Single use Unit Dose Vials (UDVs) should be discarded after each use unless otherwise
stated by the manufacturer.
 10ml of eye drops normally contains approximately 200 drops (~20 drops in 1ml)
 Eye ointments are used for local treatment of lids, for prolonged treatment at night and to
reduce the number of drops given.
 If drops and ointment are used at the same time, drops should be given first.
 Paraffin based ointments are flammable and care should be taken to avoid burns, e.g.
smoking, close contact with naked flames etc.
 A number of products are available ‘Over the Counter’ (OTC) for purchase at less than the
cost of an NHS prescription, through a community pharmacy and this may be an option for
some patients who pay for their prescriptions.
Author: Jennifer Cox Medicines Management Technician, July 2015
Approved by: Medicines Management Committee
Review date: July 2017
Acknowledgement to: Jason Punyer, NHS Rotherham CCG
Version V1
Ocular Lubricant
Formulary
First Line (Low viscosity)
Hypromellose 0.3% [generic] (excipients depend on
manufacturer, check with pharmacist)
£1.04 for 10ml
Lasts 28 days from opening (manufacturers may vary)
OR
Sno Tears® [Polyvinyl alcohol drops 1.4%]
(contains benzalkonium) £1.06 for 10ml
Lasts 28 days from opening
Second Line (Medium viscosity)
Clinitas® Gel [Carbomer 980] (contains cetrimide)
£1.49 for 10 grams
Lasts 28 days from opening
OR
Geltears® [Carbomer 980] (contains benzalkonium)
£2.80 for 10 grams
Lasts 28 days from opening
Consider preservative free preparations
where allergy is present or more than 4-6
applications per day are required
Tear -Lac® [hypromellose 0.3%]
£5.75 for 10ml (contains 300 drops)
Last 6 months from opening
OR
Liquifilm tears®
[Polyvinyl alcohol drops 1.4%]
30 x 0.4mL) Unit Dose Vials £5.35
Discard each single dose vial after use
Consider preservative free preparations
where allergy is present or more than 4-6
applications per day are required
Viscotears® [Carbomer 980]
30x0.6ml Unit Dose Vials £5.42
Discard each single dose vial after use
Consider preservative free preparations
where allergy is present or more than 4-6
applications per day are required
Third Line (Medium viscosity)
®
Systane [Hydroxypropyl guar]
(Contains propylene glycol low allergenic
preservative system)
£4.66 for 10ml
Lasts 6 months from opening
OR
Optive® [Carmellose 0.5%] (contains Purite;
biodegradable low allergenic preservative system)
£7.49 for 10ml
Lasts 6 months from opening
Fourth Line (Medium viscosity)
On specialist advice only
Oxyal® [Sodium Hyaluronate
(contains OxyD; biodegradeable low allergenic
preservative system)
£4.15 for 10ml
Lasts 60 days from opening
Celluvisc® [Carmellose 1.0%]
30x0.4mL Unit Dose Vials £3.00
Discard each single dose vial after use
OR
Systane® [Hydroxypropyl guar]
28x0.4ml Unit Dose Vials £4.66
Discard each single dose vial after use
Consider preservative free preparations
where allergy is present or more than 4-6
applications per day are required
Clinitas® [Sodium Hyaluronate 0.4%]
30x0.5mL Unit Dose Vials £5.70
Each unit dose vial (8 -10 drops) is resealable and suitable for use for up to 12 hrs
OR
®
Hylo -Tear [Sodium Hyaluronate 0.1%]
£8.50 for 10ml (contains 300 drops)
Hylo-Forte® [Sodium Hyaluronate 0.2%]
£9.50 for 10ml (contains 300 drops)
Both Last 6 months from opening
Eye ointments (High Viscosity) for use at night in addition to day time treatment
Vita-POS® preservative free ointment (retinol palmitate 250 units/g, white soft paraffin, light liquid paraffin,
liquid paraffin, wool fat) £2.75 for 5 grams Lasts 3 months from opening
Warning: Paraffin-based eye ointments are flammable; keep them away from heat, lights and naked flames.
Author: Jennifer Cox Medicines Management Technician, July 2015
Approved by: Medicines Management Committee
Review date: July 2017
Acknowledgement to: Jason Punyer, NHS Rotherham CCG
Version V1
Dry eyes education
information leaflet
Prices are correct at time of printing based on June 2015 editions of Drug Tariff / Chemist and Druggist both of which are updated on a monthly basis
Please print for patients
What is dry eye?
How to administer eye drops /
ointments (see also product leaflets)
Dry eye syndrome (dry eyes) is a common cause
of eye irritation, mainly affecting older people.
 Wash hands thoroughly with soap and water
are emollients?
Artificial tear drops, gels and soothingWhat
ointments
before
using
anyThis
eyemay
preparations
Emollients
prevent
the skin
from becoming
You can apply emollients
as and
oftenafter
as you
need.
be 2-3 times
(ocular
lubricants)
usually
help easedry.
symptoms.
Checkisthe
container,
tip to as
a day or more if your skin becomes very dry. Applying emollients 
regularly
hard
work andparticularly
tedious but the
worthwhile
Who
gets
dry
it can prevent eczema
from
flaring
up. eyes?
check it is not cracked or damaged
Dry eyes affect about 7 in 100 people in their 50’s
 Tilt your head back and pull down the lower lid
and about 15 in 100 people in their 70’s. Women
of your eye with your finger forming a pocket
are affected more often than men.

Look up and gently squeeze the dropper/tube
What causes dry eyes?
so that a single drop or a thin line of ointment
Ageing - Dry eyes gets more common with age
Medication - Some medicines can cause dry
falls into the eye pocket and remove your finger
eyes, or make dry eyes worse. These include:
 Close your eye for 1-2 minutes and tip your
diuretics (water tablets); some antidepressants;
head down without blinking or squeezing your
antihistamines; some treatments for anxiety and
eyelids and apply gentle pressure to the corner
other psychological problems; incontinence drugs;
beta-blockers such as atenolol, etc;
of your eye nearest your nose
Illness - may occur with rheumatoid arthritis,
 Shake the bottle (if drops) before applying
systemic lupus erythematosus (SLE), and
 Avoid touching the dropper/ointment tip with
Sjögren's syndrome.
anything, including eyes and eyelids to help
Increased evaporation of tears e.g. from central
heating or air conditioning.
keep it clean and free from sources of infection
Low blink rate e.g. spending a long time looking at
 Use a mirror to help you see to guide the eye
a computer, TV etc
preparation or get someone else to administer
Windy conditions when you are outside.
the eye drops/ointment for you
Inability to cover the eyes completely when closing
the eyelids.
 If using other eye preparations, allow at least 5
Damage to the outer part of the eyes, eyelids etc
minutes between different eye drops
from disease, injury or surgery.
/ointments. Use drops first, then gels or
Blepharitis (inflammation of the eyelids)
suspensions, and lastly ointments.
Which Ocular lubricant?
 Note expiry date (e.g. 28 days after opening)
There are many choices containing different
 Check storage instructions e.g. store in a fridge
ingredients although they all products serve to
moisturise the eye. It is best to start with simple
drops and then move onto thicker or longer lasting
preparations if needed.
Contact Lens Wearers
Are there any possible side-effects
from ocular lubricants?
Generally ocular lubricants are well tolerated,
however as with any applications to the eye,
stinging, irritation or blurred vision may occur. If
you experience problems talk to your doctor or
pharmacist for advice.


Generally if you have eye problems it is
better to not wear contact lens or remove
them as they can make things worse
Remove soft contact lenses before instilling
drops and wait at least 15 minutes before reinserting them
Eye drops may be instilled whilst wearing
rigid (hard) contact lenses (if in doubt check
with your optician)
DO NOT wear contact when eye ointments or
oily eye drops are used
Do I need to use preservative free

ocular lubricants?
Preservatives in eye preparations help prevent the
eye getting infections. Occasionally some people
may have an allergy to a particular preservative

found in an eye preparation and should avoid other
preparations that contain it. Preservative free eye
preparations are useful where patients have an
allergy to the preservatives used in eye
This leaflet is based upon information from
preparations or where they need to be used more
patient.co.uk; http://www.patient.co.uk
Author: Jennifer
Medicines
Technician,
Acknowledgement to: Jason Punyer, NHS Rotherham CCG
than 6Cox
times
a dayManagement
or after eye
surgery.July 2015
Approved by: Medicines Management Committee
Review date: July 2017
Version V1