11.8.1. Tear deficiency, ocular lubricants, and astringents
Patients with chronic dry eye conditions should be educated that long-term and regular use of eye lubricants is recommended to achieve maximum benefit. Many of the preparations for dry eyes are considered to be medical devices rather than medicines. The preparations listed in this section are all included in Part 3 of the Scottish Drug Tariff (Appliances) and are able to be prescribed on a GP10 prescription.
11.8.1.1. Carbomer-based preparations
Prescribing Notes:
- Clinitas gel is considered the first line treatment for dry eye conditions.
- Contains carbomer 980 0.2% as the active ingredient.
- Preservatives: cetrimide, sodium edetate.
11.8.1.2. Paraffin-based preparations
Prescribing Notes:
- Hylo-Night is the preferred paraffin-based preparation.
- The recommended frequency is once daily at night.
- Contains retinol palmitate 259units/g, white soft paraffin, light liquid paraffin, liquid paraffin and wool fat.
- Preservatives: preservative-free.
Prescribing Notes:
- Contains white soft paraffin, white mineral oil and lanolin alcohols.
- Preservatives: preservative-free.
11.8.1.3. Sodium hyaluronate preparations
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Considered the first line sodium hyaluronate preparation.
- Contains sodium hyaluronate 0.2%, polyethylene glycol 0.25%.
- Preservatives: borax, boric acid.
Restrictions:
Restricted to use in severe dry eye only.
Prescribing Notes:
- This preparation should be considered for patients with dexterity problems and for whom this administration system is suitable.
- Contains sodium hyaluronate
- Preservatives: preservative-free.
Restrictions:
Restricted to use in severe dry eyes when Blink Intensive Tears or Eyeaze are not appropriate and the addition of trehalose is desirable (corneal damage).
Prescribing Notes:
- Contains sodium hyaluronate (0.15%) and trehalose (3%)
- Preservatives: preservative-free
11.8.1.4. Carmellose-based preparations
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Contains carmellose sodium 0.5%
- Preservatives: preservative-free; contains boric acid which can be an eye irritant.
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Single dose units contain carmellose sodium 0.5%.
- Preservatives: preservative-free.
11.8.1.5. Other ocular lubricant preparations
Restrictions:
Restricted to initiation by consultant ophthalmologists for the treatment of severe keratitis in adults with dry eye disease which has not improved despite treatment with tear substitutes.
Prescribing Notes:
Prescribe by brand.
Restrictions:
Excludes single dose unit preparations.
Prescribing Notes:
Use for short-term management of simple dry-eye. Other treatment options may be more appropriate for chronic dry eyes.
Contains hypromellose 0.3%. Preservatives may include benzalkonium chloride.
Restrictions:
Restricted to initiation by specialist for use in severe dry eyes only.
Prescribing Notes:
- Contains acetylcysteine 5%
- Preservatives: benzalkonium chloride, disodium edetate
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Do not use more than four times daily
- Contains propylene glycol, hydroxypropyl guar, mineral oil, dimyristoyl phosphatidylglycerol, polyoxyl 40 stearate, sorbitan tristearate, boric acid, sorbitol, edetate disodium, and POLYQUAD® (polyquaternium-1) 0.001% preservative.