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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 11 - Eye 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
11.08.01 Tear deficiency, ocular lubricants, and astringents
BLMK Guidelines for Dry Eye Management

Acetylcysteine 10% eye drops

RED
Restricted Drug Restricted

Filamentary keratitis where 5% acetylcysteine is not effective.

Unlicensed special

 

Entry reviewed: Nov 2021

BNF BNFc SPC

Acetylcysteine 5% eye drops

Amber SPA
Formulary

Entry reviewed: Nov 2021

BNF BNFc SPC

Carbomer 0.2%

GREEN
Formulary

Self Care Self-care

 

Primary care prescribing: Most cost effective brand to be advised via OptimiseRx

Hospital prescribing: brand supplied will depend on availability.

Brands include:

Clinitas (contains preservative),

Evolve (preservative free)

 

Restricted Item Please note preservative free Evolve brand is reserved for patients unable to tolerate preservatives. (Expiry of multidose bottle is 3 months after opening for Evolve brand).

 

 NPSA Alert Update 02 April 2024:

As of 21 March 2024, the UK Health Security Agency (UKHSA) and the multi-stakeholder Incident Management Team are satisfied that the risk associated with this outbreak has reduced. The Medicines and Healthcare products Regulatory Agency (MHRA) are satisfied that carbomer-containing lubricating eye products available on the UK market are safe to use. There is no longer an indication to avoid use of these products (aside from those that have been previously recalled). Therefore, the recommendation previously communicated to ‘avoid the use of all carbomer-containing eye products in individuals with cystic fibrosis, patients being cared for in critical care settings, the severely immunocompromised and patients awaiting lung transplantation’ is no longer required and has been stepped down.

The other recommendations within this National Patient Safety Alert remain. UKHSA has published further information on this outbreak in the Health Protection Report - Outbreak of Burkholderia cepacia complex associated with carbomer-containing lubricating eye products in the United Kingdom, 2023 to 2024 which can be accessed from the link below:

https://www.gov.uk/government/publications/health-protection-report-volume-18-2024/hpr-volume-18-issue-3-news-14-march-2024#outbreak-of-burkholderia-cepacia-complex-associated-with-carbomer-containing-lubricating-eye-products-in-the-united-kingdom-2023-to-2024

Entry reviewed: 

April 2024

BNF BNFc SPC
Specific brands of carbomer eye gel: recall of AACARB eye gel, AACOMER eye gel and PUROPTICS eye gel: potential risk of infection

Carboxymethylcellulose, glycerine, Castor oil eye drops

Amber SPA
Formulary

Approved for use in line with BLMK dry eye guidance

 

Brands inclide:

Optive plus

 

Entry reviewed: Nov 2021

BNF BNFc SPC

Carmellose Sodium 0.5% and 1% eye drops

GREEN
Formulary

Second line after hypromellose for use where preservatives are not tolerated

Consider self care 

 

Eyeaze Carmellose 0.5% (10ml preservative free bottle) 

Eyeaze Carmellose 1% (10ml preservative free bottle) 

VIZcellose 0.5% (10ml preservative free bottle) 

VIZcellose 1% (10ml preservative free bottle) 

 

 

 

Entry reviewed: June 2023

BNF BNFc SPC

Ciclosporin 1mg/mL Eye drops, emulsion
(For ophthalmology use)

Amber SPA
Restricted Drug Restricted

Restricted - initiation by consultant ophthalmologists in the corneal clinic for the treatment of severe keratitis in adult patients with dry eye disease that has not improved despite treatment with tear substitutes in accordance with NICE TA369.

 

Brands include:

Ikervis

 

Entry reviewed: Nov 2021

BNF BNFc SPC
NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears

Coenzyme Q10, carboxymethylcellulose (carmellose), poloxamer 407
(Preservative free eye gel/drops)

Amber SPA
Restricted Drug Restricted

For the treatment of moderate to severe dry eyes with corneal staining

For use after complex corneal surgery

 

Drops to be used 2nd line - only where gel is not tolerated

 

Brands include:

VisuXL Gel

VisuXL Drops 

 

Entry reviewed: Nov 2021

BNF BNFc SPC

Hypromellose 0.3% eye drops

GREEN
Formulary

Self Care Self-care - Patients should be advised to purchase a suitable product over the counter for mild/moderate cases.

 

Primary care: Most cost effective brand to be advised via OptimiseRx 

Current 1st line cost-effective brands:  

Aapromel or Aaculose 0.3% or 0.5%

 

 

Entry reviewed: May 2023

BNF BNFc SPC

Liquid Paraffin eye ointment

GREEN
Formulary

Primary care: Most cost effective brand to be advised via Optimise Rx

Hospital: brand supplied will depend on availability.

L&D: Lacri-Lube is still unavailable. We are purchasing VitA-POS ointment as a substitute but note this has changed its name to Hylo Night. Prescribe generically on ePMA as 'liquid paraffin eye ointment'.

 

Brands include:

Hylonight

 

Entry reviewed: Nov 2021

BNF BNFc

Omega-3 essential fatty acids, Vitamins A and D and ultra-filltered phospholipid eye drops

Amber SPA
Restricted Drug Restricted

Restricted: For meibomian gland dysfunction

Approved for use as per BLMK Dry Eye Guidance

 

Brands include: 

VisuEvo

 

Entry reviewed: Nov 2021

BNF BNFc SPC

Sodium Chloride 5% eye products

GREEN
Formulary

Preservative-free Eye Ointment
Preservative-free eye drops x 10ml

 

For use in in patients with corneal oedema

 

Entry reviewed: May 2023

Sodium Hyaluronate
(0.1%, 0.2%, 0.4% Preservative free eye drops)

GREEN
Formulary

For treatment of dry eye

Secondary care: Prescribe generically

Primary care: Most cost effective brand to be advised via OptimiseRx (currently Eyeaze)

 

Brands include:

Eyeaze (contains phosphate buffer)

Hydramed

 

Entry reviewed: Nov 2021

BNF BNFc SPC
EMA review Questions and answers on the use of phosphates in eye drops Dec 2012

Sodium hyaluronate 0.15% with trehalose 3% carbomer 0.25% eye gel (Thealoz Duo Gel ®)
(Preservative free gel formularion)

RED
Formulary

TEMPORARY APPROVAL DURING PERIOD OF CARBOMER 0.2% GEL SHORTAGE

 

To be used only in the following locations:

  • OPD eye clinic 
  • OPD eye day surgery

 

Entry reviewed: November 2023

 

 

BNF BNFc SPC

Sodium hyaluronate 0.15% with trehalose 3% eye drops
(Preservative free eye drops)

GREEN
Formulary

For treatment of severe dry eye

Secondary care: Prescribe generically.

Primary care: Prescriptions should be changed to the most cost effective brand once care is transferred 

PRESERVATIVE FREE multidose bottle can be used for up to 3 months after opening

 

Brands include:

Thealoz Duo

 

Entry reviewed: Nov 2021

BNF BNFc SPC

Sodium Hyaluronate 0.2%, Carbomer 980 and Glycerol eye drops

Amber SPA
Formulary

Approved for use as per BLMK Dry eye guidance

 

Brands include:

Evolve Revive

 

Entry reviewed: Nov 2021

BNF BNFc SPC
Non formulary items

0.1% Hyaluronic Acid and 2% Dexpanthenol eye drops (Hylo-Care® eye drops)

 
Non Formulary
BNF BNFc SPC

Acetylcysteine 5% with Hypromellose 0.35% (Ilube®)

 
Non Formulary
BNF BNFc SPC

Hydroxyethylcellulose (Minims® Artificial Tears)

 
Non Formulary
BNF BNFc SPC

Hydroxypropyl Guar (Systane®)

 
Non Formulary
BNF BNFc SPC

Hypromellose 0.3% with Dextran 70 0.1% (Tears naturale®)

 
Non Formulary
BNF BNFc SPC

Liquid Paraffin and Liquid Paraffin light eye drops

 
Non Formulary
BNF BNFc SPC

Liquid Paraffin eye ointment (Xailin Night®)

 
Non Formulary
BNF BNFc SPC

Optive® Fusion

 
Non Formulary
BNF BNFc SPC

Paraffin Yellow Soft

 
Non Formulary
BNF BNFc SPC

Polyvinyl Alchohol 1.4% (Eye Drops )

 
Non Formulary
BNF BNFc SPC

Simple eye ointment

DNP
Non Formulary

Very high cost ~£100 per tube. Do not prescribe.

 

Entry reviewed: August 2025

BNF BNFc SPC

Sodium Chloride 0.9% (Minims® Saline) (Single use, preservative-free)

 
Non Formulary

Removed March 2022 - single use plastic & many other options available

Sodium Hyaluronate (Lubristil®)

 
Non Formulary
BNF BNFc SPC

Sodium Hyaluronate (Vismed® Gel)

 
Non Formulary
BNF BNFc SPC

Sodium Hyaluronate (Vismed® multi)

 
Non Formulary

Sodium Hyaluronate 0.1% and 0.2% eye drop (Hylo-tear® Hylo-Forte®)

 
Non Formulary
BNF BNFc SPC

Soybean oil unit dose eye drops (Emustil®)

 
Non Formulary
BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.