Formulary 2011v4 2

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OptometristsFormulary
August2011
CompiledandProducedbyProfessorJohnLawrensonand ProfessorDavidThomsonDepartmentofOptometryand VisualScienceCityUniversityLondon TheCollegeofOptometrists
Acetazolamide........................................................................................................................... 9 Aciclovir...................................................................................................................................11 Acrivastine............................................................................................................................... 13 AntazolineSulphate ................................................................................................................. 15 Aspirin......................................................................................................................................17 AtropineSulphate .................................................................................................................... 20 AzelastineHydrochloride........................................................................................................ 23 Carbomers............................................................................................................................... 25 CarmelloseSodium.................................................................................................................. 27 CetirizineHydrochloride.......................................................................................................... 29 Chloramphenicol..................................................................................................................... 32 ChlorphenamineMaleate ........................................................................................................ 35 CyclopentolateHydrochloride ................................................................................................. 38 Diclofenacsodium................................................................................................................... 41 Doxycycline.............................................................................................................................. 44 Emedastine.............................................................................................................................. 47 EpinastineHydrochloride........................................................................................................ 49 EyeNutrients........................................................................................................................... 51 FluoresceinSodium................................................................................................................. 53 Fluorometholone..................................................................................................................... 55 Flurbiprofen............................................................................................................................. 57 FlurbiprofenSodium................................................................................................................ 59 Fusidicacid.............................................................................................................................. 61 HomatropineHydrobromide................................................................................................... 63 SodiumHyaluronate................................................................................................................ 66 Hydroxyethylcellulose............................................................................................................. 69 Hypromellose.......................................................................................................................... 71 Ibuprofen.................................................................................................................................73 KetorolacTrometamol............................................................................................................ 76 Ketotifen..................................................................................................................................78 Levocabastine.......................................................................................................................... 80 LidCareProducts..................................................................................................................... 81 LidocaineHydrochloride .......................................................................................................... 83
(Lignocaine)............................................................................................................................. 83 LiquidParaffin..........................................................................................................................85 LissamineGreen...................................................................................................................... 87 Lodoxamide............................................................................................................................. 89 Loratadine............................................................................................................................... 91 LoteprednolEtabonate ............................................................................................................ 93 Minocycline............................................................................................................................. 95 NedocromilSodium................................................................................................................. 98 Ofloxacin................................................................................................................................100 Olopatadine........................................................................................................................... 102 OxybuprocaineHydrochloride.............................................................................................. 104 (Benoxinate).......................................................................................................................... 104 Oxytetracycline...................................................................................................................... 106 Paracetamol ........................................................................................................................... 108 Paraffin,Yellow,Soft............................................................................................................. 111 PhenylephrineHydrochloride............................................................................................... 113 Pilocarpine............................................................................................................................. 116 PolymyxinBSulphate............................................................................................................ 119 Povidone................................................................................................................................121 Prednisolone.......................................................................................................................... 123 PropamidineIsetionate/........................................................................................................ 126 DibromopropamidineIsetionate........................................................................................... 126 PropylethyleneGlycol400 ..................................................................................................... 128 ProxymetacaineHydrochloride............................................................................................. 130 PolyvinylAlcohol................................................................................................................... 132 Rimexolone............................................................................................................................ 134 RoseBengal........................................................................................................................... 136 SodiumCromoglicate............................................................................................................ 138 SoyaLecithin.......................................................................................................................... 140 TetracaineHydrochloride...................................................................................................... 142 (Amethocaine)....................................................................................................................... 142 Tetracycline........................................................................................................................... 144 TropicamideHydrochloride................................................................................................... 146
OptometristsFormularyBackgroundNotes
Introduction ThefollowingnotesonthelegislativeframeworkgoverningtheuseofMedicinesAct exemptionsaretakenfrom: http://www.mhra.gov.uk/Howweregulate/Medicines/Availabilityprescribingsellingandsupply ingofmedicines/ExemptionsfromMedicinesActrestrictions/Optometrists/CON009694 Details of the individual drugs, their use, availability and contraindications can be found in the Optometrists Formulary section of eMedINFO, which is provided free to all College members. For guidance on professional conduct optometrists are referred to the Colleges Code of Ethics and Guidance for Professional Conduct, particularly Chapter 40. Prescribing optometrists are also referred to the College Guidance for Optometrist Prescribers, which gives more detail as to prescribing optometrists responsibilities. Both documents are availableinthepublicsectionofwww.collegeoptometrists.org Medicineslegislationinoptometricpractice(from30June2005) Under the Medicines Act 1968 medicines classified as Pharmacy (P) medicines may be sold or supplied only through registered pharmacies by or under the supervision of a pharmacist (section 52). Prescription only (POM) medicines are subject to an additional requirement: they may only be sold or supplied through pharmacies against a doctor's or dentist's prescription(section58).GeneralSaleList(GSL)medicinesmaybesoldmorewidelythrough otherretailoutlets(sections51and53). Exemptionsfromthegeneralrulesarepermittedforoptometrists.Theseareprovidedforin thePrescriptionOnlyMedicine(HumanUseOrder)1997SINo1830(The"POMOrder"),the Medicines (Pharmacy and General Sale Exemption) Order 1980 SI No 1924, the Medicines (SaleorSupply)(MiscellaneousProvisions)Regulations1980SINo1923. Registeredoptometrists Provideditis inthecourse oftheirprofessionalpractice,registeredoptometristsmaysellor supplythefollowingmedicinalproductstoapatient: All medicinal products on a General Sale List (Note: Under medicines legislation productswhichareforuseaseyedropsoreyeointmentsareexcludedfromtheGSL category.);and AllPmedicines. Provided it is in the course of their professional practice and in an emergency, registered optometristsmaysellorsupply: POMs which are not for parenteral administration and which: a. are eye drops and contain not more than 0.5 per cent chloramphenicol or b. are eye ointments and contain not more than 1 per cent chloramphenicol c.containthefollowingsubstances: Cyclopentolatehydrochloride FusidicAcid Tropicamide ThePOMsto whichthisexemptionappliesmayalsobesoldorsuppliedbyapersonlawfully conductingaretailpharmacybusinessonthepresentationofanordersignedbyaregistered ophthalmicoptician.
Additionalsupplyoptometrists In addition to being able to access the medicines listed above, those optometrists who have undergoneadditionaltrainingandareaccreditedbytheGeneralOpticalCouncil(additional supply optometrists) are able to sell, supply or write an order for an extended range of medicines. Provided it is in the course of their professional practice and in an emergency, additional supply optometrists can sell or supply prescription only medicines containing the following substances: Acetylcysteine Atropinesulphate Azelastinehydrochloride Dicofenacsodium Emedastine Homatropinehydrobromide Ketotifen Levocabastine Lodoxamide Nedocromilsodium Olopatadine Pilocarpinehydrochloride Pilocarpinenitrate PolymyxinB/bacitracin PolymyxinB/trimethoprim Sodiumcromoglycate ThePOMsto whichthisexemptionappliesmayalsobesoldorsuppliedbyapersonlawfully conductingaretailpharmacybusinessonthepresentationofanordersignedbyaregistered ophthalmic optician.An order made under the Opticians Act 1989 provides that where it appears to a registered optometrist that a person consulting him/her is suffering from an injury or disease of the eye, the optometrist shall refer that person to a registered medical practitioner,exceptinspecifiedcircumstancesincludinganemergencyorwhereotherwiseit is impractical or inexpedient to do so or there is no justification for such a referral. There is no legal definition of what is "an emergency" for the purposes of the Medicines Act exemptionsorthespecific criteriagoverningreferralundertheOpticiansAct.Itistherefore for the optometrist to make a professional judgement as to whether there is in fact an emergencyandwhatmeasuresneedtobetakeninthebestinterestsofthepatient,bearing inmindtheOpticiansAct,theGOCrulesandMedicineslegislation. All POMs and P medicines to which Medicines Act exemptions apply may be sold to a registeredoptometristbywayofwholesaledealing. Also, under the Medicines (Sale or Supply) (Miscellaneous Provisions) Regulations 1980, a registered optometrist may obtain the following medicinal products by way of wholesale dealing: Pmedicinesforadministrationinthecourseofhisbusiness. POM medicines for administration (as opposed to sale or supply) containing the following substances: Amethocainehydrochloride Lignocainehydrochloride Oxybuprocainehydrochloride Proxymetacainehydrochloride
An additional supply optometrist will also be able to obtain thymoxamine hydrochloride via wholesaledealingshouldacommercialpreparationbecomeavailable. Contentsofawrittenordertothepharmacisttosupplyamedicinetothepatient An order for POMs should include: optometrist's name and address, the date, name and address of the patient (if applicable), the purpose for which the POM is to be supplied (eg use in professional practice, refraction, etc), name, quantity, and except where apparent from the name, the pharmaceutical form and strength of the POM, labelling directions (where applicable), the signature of the optometrist (which must be original). The signed order must be written in indelible ink (includes typewritten and computer generated orders). Pharmacymedicines Forthepurposesoftheparagraphsabove,eyedropsandeyeointmentscontainingthe followingsubstancesareclassedasPmedicines: Antazoline(upto1%) Azelastinehydrochloride(upto0.1%forthetreatmentofthesignsandsymptomsof allergicconjunctivitis Dibromopropamidineisethionate Fluoresceinsodium Levocabastine (up to 0.05% for the symptomatic treatment of seasonal allergic conjunctivitis Lodoxamide(upto0.1%forocularsignsandsymptomsofallergicconjunctivitis Phenylephrinehydrochloride Propamidineisethionate RoseBengal Sodiumcromoglicate(Onlyforthetreatmentofacuteseasonalallergicconjunctivitis or perennial allergic conjunctivitis and subject to a maximum strength of 2% for eye dropsor4%foreyeointment.Productscontainingthissubstancearealsosubjectto restrictions on maximum quantity which may be sold or supplied as a P medicine. Thesearenotmorethan10mlforeyedropsand5gforeyeointment.) Varioustearsupplementsandocularlubricants Xylometazolinehydrochloride
SupplementaryandIndependentprescribing
SupplementaryPrescribing Supplementary prescribing is defined as 'a voluntary partnership between an independent prescriber (a doctor or dentist) and a supplementary prescriber to implement an agreed patientspecific clinical management plan with the patient's agreement'. The plan sets out how much responsibility should be delegated and refers to a named patient and to their specific condition. Agreement to the plan must be recorded by both the independent and supplementary prescriber before supplementary prescribing begins. Both prescribers must alsoshareaccesstoacommonpatientrecord. Supplementary prescribing for optometrists was introduced July 2005. Accreditation for specialist registration as a supplementary prescriber involves a course of further training approved by the GOC followed by the College of Optometrists CFA for Specialist Qualifications in Therapeutics (Supplementary Prescribing). Since 2009, supplementary prescribinghasbeenintegratedintotheCFAforindependentprescribing. Although there are no legal restrictions on the clinical conditions that supplementary prescriberscantreatnorthemedicinesthattheycanprescribe,sincethistypeofprescribing requires a prescribing partnership with an independent prescriber and an agreed clinical managementplanbeforeitcanbegin,itismostusefulwhendealingwithlongtermmedical conditions,suchasglaucoma. IndependentPrescribing Statutory legislation to enable independent prescribing by optometrists was introduced in June 2008. The proposed amendments were subject to public consultation and advice to Ministers by the Commission on Human Medicines (CHM). The CHM's recommendation was that suitably qualified optometrists should be able to prescribe any licensed medicine (except for controlled drugs or medicines for parenteral (injected) administration) for conditions affecting the eye, and the tissues surrounding the eye, within their recognised area of expertise and competence. Independent prescribers will be able to prescribe privately and where suitable arrangements have been made, write an NHS prescription. Accreditation for independent prescribing involves a course of further training approved by the GOC followed by the College of Optometrists CFA for Specialist Qualifications in Therapeutics (Independent Prescribing). Independent prescriber specialist registrants will also be accredited as supplementary prescribers and to supply drugs as additional supply optometrists. CollegeofOptometristsClinicalManagementGuidelines The scope of optometrist independent prescribing is defined by the College Clinical Management Guidelines (CMGs), which provide a reliable source of evidencebased information on the diagnosis and management of a number of eye conditions that present with varying frequency in primary and firstcontact care. Whilst they are intended specifically for specialist therapeutic prescribers, it is anticipated that all optometrists will find them a useful source of information. The CMGs are available from the College website www.collegeoptometrists.org
PregnancyRiskCategories
The FDA has a categorization of drug risks to the fetus that runs from: "CategoryA"(safest)to"CategoryX"(knowndangerdonotuse!) CategoryA Controlled studies in women fail to demonstrate a risk to the foetus in the first trimester (and there is no evidence of a risk in later trimesters), and the possibility of foetal harm appearsremote. CategoryB Either animalreproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women, or animalreproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studiesinwomeninthefirsttrimester(andthereisnoevidenceofariskinlatertrimesters). CategoryC Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women, or studies in women andanimalsarenotavailable.Drugsshouldbegivenonlyifthepotentialbenefitjustifiesthe potentialrisktothefetus. CategoryD There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a lifethreatening situationorforaseriousdiseaseforwhichsaferdrugscannotbeusedorareineffective). CategoryX Studies in animals or human beings have demonstrated foetal abnormalities, or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated inwomenwhoareormaybecomepregnant.
Acetazolamide

LegalClassification
POM:Maybeusedandprescribedbyindependentprescribingoptometrists.
AvailablePreparations
Acetazolamide:tablets,250mgacetazolamide(Nonproprietary) Diamox:tablets,250mgacetazolamide(Goldshield) DiamoxSR:tablets(modifiedrelease),250mgacetazolamide(Goldshield)
DrugType
Antiglaucoma.
Classification
Carbonicanhydraseinhibitor.
Indications
Emergency treatment of acute angle closure prior to surgery. See Clinical Management Guidelineonangleclosureglaucoma.
Contraindications
Hypersensitivity to acetazolamide or component of the preparation. Contraindicated in marked renal or hepatic disease. Acetazolamide should not be used in patients hypersensitivetosulphonamides.
Cautions
Noneforemergencytreatment.
PregnancyandLactation
Pregnancy risk category B: Animal studies have reported embryotoxicity and teratogenicity in high doses and since there are no adequate and wellcontrolled studies in pregnant women, acetazolamide should be used in pregnancy only if the potential benefit to the motherclearlyoutweighsanypossiblerisktothedevelopingfoetus.Althoughacetazolamide has been reported to be excreted in human breast milk it is unlikely to lead to harmful effectsfollowingemergencyuse.
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Interactions
Nonerelevanttotheemergencyuseofacetazolamide.
OcularSideEffects
Transientmyopia
OcularSideEffectsNotes
Ocularsideeffectsareunlikelyinemergencyuse.
GeneralSideEffects
Gastrointestinaldisturbancese.g.nausea,vomitinganddiarrhoea Tinglingfeelingintheextremities Polyuria Thirst Headache Flushing Dizziness
GeneralSideeffectsNotes
Generalsideeffectsareunlikelyinemergencyuse.
Dose
Adults:250mgsingle(stat)dose(followedbyemergencyreferraltoanophthalmologist).
Storage
Storebelow30C.
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Aciclovir

LegalClassification
Zovirax:eyeointment,3%aciclovir(GSK)
Drugtype
Antiinfective.
Classification
Antiviral.
Indications/Use
Aciclovir is indicated for the treatment of herpes simplex keratitis. See Clinical Management GuidelineonHerpesSimplexKeratitis.
Contraindications
Hypersensitivitytoacicloviroranycomponentofthepreparation.
Cautions
Patientsshouldavoidwearingcontactlensesduringtreatmentwithaciclovireyeointment.
Pregnancy risk category B. A postmarketing aciclovir registry has documented pregnancy outcomes in women exposed to any formulation of aciclovir. No unique or consistent pattern of birth defects has been reported. However, the use of acyclovir during pregnancy requires that the benefits be weighed against the potential risks to the foetus. Following systemic administration, aciclovir has been detected in the milk of nursing mothers. However, the dosage received following the use of aciclovir eye ointment is likely to be insignificant.
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allow510minutesbetweenapplicationsofeachpreparation.
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OcularSideEffects
Superficialpunctatekeratopathy Transientmildstingingoninstillation Blepharitis
OcularSideeffectsNotes
SPK is very commonly reported. Transient stinging on instillation is common, whereas blepharitisisararesideeffect.
GeneralSideeffects
Hypersensitivityreactions
Veryrarely,hypersensitivityreactionsincludingangioedemahavebeenreported.
Dose
For adults & children (all ages): 1cm ribbon of ointment should be place in the lower conjunctival sac 5 times a day at approximately 4 hourly intervals (omitting overnight application).Treatmentshouldbecontinuedforatleast3daysafterhealingiscomplete.
Storage
Storebelow30C.
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Acrivastine

LegalClassification
GSL:Foruseandsupplybyalloptometrists.
BenadrylAllergyRelief:capsules,8mgacrivastine(McNeilProductsLtd) BenadrylPlusCapsules:8mgacrivastine,60mgpseudoephedrine(McNeilProductsLtd)
DrugType
Antihistamine.
Classification
Nonsedativeantihistamine.
Indications
Forthesymptomaticreliefofallergicrhinitis(hayfever)anditsassociatedocularsymptoms, perennial rhinitis and chronic idiopathic urticaria. See Clinical Management Guideline on Conjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytoacrivastineoranycomponentofthepreparation.
Cautions
Second generation antihistamines are less lipophilic and do not penetrate the bloodbrain barrier to any significant extent. They are therefore less likely to cause centrally mediated effects e.g. drowsiness. However, small numbers of patients experience such effects and thereforetheyneedtobe warnedthat acrivastinemayaffectdrivingandother skilledtasks. Acrivastine has a greater propensity to induce drowsiness than either cetirizine and loratidine. Usewithcautioninpatientswithrenalorhepaticimpairment. Products containing pseudoephedrine are contraindicated in patients with hypertension, heartdisease,diabetesandinpatientspredisposedtonarrowangleglaucoma.
Pregnancy risk category B: Animal studies, using oral doses many times higher than the recommended human dose, found no teratogenic effects. However, there are no adequate
and wellcontrolled studies in pregnant women. Because animal studies are not always predictiveof humanresponses,acrivastineshould beusedin pregnancyonlyif thepotential benefit to the mother clearly outweighs any possible risk to the developing foetus. Acrivastine has been reported to be excreted in human breast milk and is therefore not recommendedinnursingmothers.
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Interactions
Avoidexcessivealcoholconsumption. The concomitant use of pseudoephedrinecontaining products and monoamine oxidase inhibitorsmaycauseariseinbloodpressure.
OcularSideEffects
Dryeyes Punctatekeratitis
Ocularsideeffectsarerare.
GeneralSideEffects
Drowsiness Skinrash Urinaryretention
General side effects are rare. Rashes and urinary retention have been associated with the useofpseudoephedrine.
Dose
Adults&children(12yearsandover).One8mgcapsuleuptothreetimesaday. Notrecommendedinelderlypatients(>65years).
Storage
Storebelow30C.
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Antazoline Sulphate

LegalClassification
P:Foruseandsupplybyalloptometrists.
OtrivineAntistin: eye drops, 0.5% antazoline sulphate, 0.05% xylometazoline hydrochloride (NovartisConsumerHealth)
DrugType
Antiinflammatory.
Classification
Antihistamine.
Indications
For the temporary relief of redness and itching of the eye due to seasonal and perennial allergiessuchashayfeverorhousedustallergy. SeeClinicalManagementGuidelineonConjunctivitisseasonalandperennialallergic.
Contraindications
Hypersensitivity to antazoline, xylometazoline or any component of the preparation. Should notbeusedinpatientstakingmonoamineoxidaseinhibitorswithinthelast14days.
Cautions
The only preparation available in the UK contains xylometazoline, which is a sympathomimetic and should be avoided in patients at risk of angle closure glaucoma. Use with caution in elderly patients with severe cardiovascular disease, including arrhythmia, poorly controlled hypertension, or diabetes. Similarly, sympathomimetics should also be used with caution in the presence of hypertension, cardiac irregularities, hyperthyroidism diabetes mellitus or phaeochromocytomas, also in patients with conditions causing urinary retention such as prostatic hypertrophy or patients who are currently receiving other sympathomimeticdrugs. Contactlenswearshouldnotbewornduringtreatment.Preparationcontainsbenzalkonium chlorideasapreservative,whichmayaccumulateinsoftlensesandcauseirritation.
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Pregnancy risk category C. Safety in pregnancy has not been established. Should be used withcautionduringpregnancyandonlyiftheexpectedbenefittothemotherisgreaterthan anypossiblerisktothedevelopingfoetus. It is not known whether antazoline is excreted in breast milk. Its use in nursing mothers thereforerequiresthatthebenefitsbeweighedagainstthepotentialriskstotheinfant.
Interactions
Should not be used in patients receiving monoamine oxidase inhibitors or within 14 days of stoppingsuchtreatment(riskofhypertensivecrisis).Shouldbeusedwithcautioninpatients receiving other medications such as digitalis, betaadrenergic blockers, guanetidine, reserpine,methyldopaorantihypertensiveagents. Sedating antihistamines can enhance the sedating effects of CNS depressants including alcohol, hypnotics, opioid analgesics, anxiolytic sedatives, and antipsychotics. They also have an additive antimuscarinic action with other antimuscarinic drugs, such as atropine, andsomeantidepressants In the case of concomitant use of another topical eye preparation, allow 510 minutes betweenapplicationsofeachpreparation.
OcularSideEffects
Transientstinging Blurring Conjunctivalhyperaemia Conjunctivalfollicles Localallergicreaction(rash,oedema,pruritus) Acuteclosedangleglaucoma
Rebound hyperaemia may occur. Ocular side effects are uncommon and typically transient. Xylometazoline is a sympathomimetic and may precipitate angle closure glaucoma in susceptibleindividuals.Recentcasereportsofseverefollicularconjunctivitis.
GeneralSideEffects
Headaches Dizziness Drowsiness
Dose
Adults&children(12yearsandover)apply1droptwotothreetimesdaily.
Storage
Storebelow25C.
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Aspirin

LegalClassification
POM:Maybeusedandprescribedbyindependentprescribingoptometrists. P:Foruseandsupplybyalloptometrists. GSL:Foruseandsupplybyalloptometrists.
POM: Aspirin:tablets,300mgaspirin(Nonproprietary) Caprin:tablets,300mgaspirin(PInewood) NusealsAspirin:tablets,300mgaspirin(Alliance) PandGSL(upto16tablets,GSL,upto32tablets,P,>32TabletsclassedasPOM): Aspirin:tablets,300mgaspirin(Nonproprietary) AnadinOriginal:tablets,325mgaspirin(WyethConsumerHealthcare) AsproClear:tablets,300mgaspirin(BayerPLCConsumerHealthcare) Aspro Clear Maximum Strength: soluble tablets, 500mg aspirin (Bayer PLC Consumer Healthcare) Disprin:tablets,300mgaspirin(ReckittBenckiserHealthcare) Combinationproducts: PandGSL: AnadinExtra:tablets,300mgaspirin,200mgparacetamol(WyethConsmerHealthcare) Codis 500 Soluble Tablets: 500mg aspirin, 8mg codeine phosphate (Reckitt Benckiser Healthcare) DisprinExtra:tablets,300mgaspirin,200mgparacetamol(ReckittBenckisterHealthcare)
DrugType
Nonopioidanalgesics.
Classification
Nonsteroidalantiinflammatoryanalgesic.
Indications
Mildtomoderatepainfromavarietyofcauses.
Contraindications
Aspirin should be avoided in patients with gastric ulcers or a history of gastric problems and in patients with a history of bleeding disorders oronanticoagulant therapy must avoid OTC
aspirin products. Due to risk of Reyes Syndrome aspirin is no longer licensed in children undertheageof16.
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Cautions
The elderly are at increased risk of NSAIDinduced adverse reactions. Particular caution is required in patients with renal, cardiac or hepatic impairment. The dose should be as low as possible.Usewithcautioninpatientswithasthma.
PregnancyriskcategoryD.TherehavebeenreportsofNSAIDtoxicityduringtheearlystages of pregnancy in animal studies. Most manufacturers therefore recommend that aspirin should not be used during pregnancy. Aspirin passes into breast milk in very low levels and duetotheriskofReyesSyndromeitshouldbeavoidedinnursingmothers.
Interactions
Should not be used with other NSAIDs. Aspirin potentiates the anticoagulant effect of warfarin and may enhance the effects of oral hypoglycaemics of the sulphonylurea type and alsoenhancethetoxicityofmethotrexate. Alcoholandcorticosteroidsmayenhancetheeffectsofaspirinonthegastrointestinaltract
OcularSideEffects
Transientblurring Refractivechanges Dryeyes Colourvisiondisturbances
Ocular side effects are rare and have generally been described in patients taking high doses. Therehavebeenrarereportsoftransientmyopia.
GeneralSideEffects
Abdominalpain,nauseaanddyspepsia Pepticulcerandgastrointestinalhaemorrhage. Hypersensitivityreactions
Dyspepsia is relatively common, other side effects are rare. Hypersensitivity reactions have been reported following treatment with aspirin, consisting of urticaria, rhinitis, angioneuroticoedemaandseverebronchospasm.
Dose
Adults & children (16 years and over): 300900mg every 46 hours, with or after food. Maximumdailydose3600mg.
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Storage
Storebelow25C.
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Atropine Sulphate

LegalClassification
POM: For use and supply by additional supply optometrists. May be used and prescribed by independentprescribingoptometrists.
AtropineSulphate:eyedrops,0.5%atropinesulphate(nonproprietary) AtropineSulphate:eyedrops,1%atropinesulphate(nonproprietary) AtropineSulphate:eyeointment,1%atropinesulphate(nonproprietary) SingleUse(Preservativefree): MinimsAtropineSulphate:eyedrops,1%atropinesulphate(Bausch&Lomb)
DrugType
Mydriaticandcycloplegic.
Classification
Antimuscarinic.
Indications
As a topical cycloplegic. Also used for dilating the pupil in anterior uveitis, the alleviation of ciliary spasm following corneal abrasion and for penalisation therapy in amblyopia. See ClinicalManagementGuidelinesonCornealAbrasionandAnteriorUveitis.
Contraindications
Hypersensitivitytoatropineoranycomponentofthepreparation. Contraindicatedinpatientswithconfirmedorsuspectednarrowangleglaucomaasanacute attackmaybeprecipitated.
Cautions
Riskofsystemic effectsininfants <3 months (eye ointment preferredasitreducessystemic absorption). Use with caution in patients at higher risk of systemic effects e.g. debilitated or elderly patients or patients with Downs Syndrome. Children with brain damage may also demonstrate ahyperreactiveresponsetoatropine.Systemicabsorptionmaybereducedby compressing the lacrimal sac at the medial canthus during, and for 23 minutes after instillationofthedrops. Multidose aqueous formulations contain benzalkonium chloride as a preservative and shouldnotbeusedwhensoftcontactlensesareworn.
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Pregnancy risk category C. Safety of atropine for use in pregnancy has not been established. Atropine passes into breast milk in small amounts and may cause anticholinergic effects in babies of nursing mothers. Atropine should therefore be used in pregnancy and lactation only where benefits to the mother outweigh the potential risks to the developing foetus or baby.
Interactions
The effect of antimuscarinic agents may be enhanced by the concomitant administration of other drugs with antimuscarinic properties such as amantadine, some antihistamines, butyrophenones, phenothiazines and tricyclic antidepressants. In the case of concomitant use of another topical eye preparation, allow 510 minutes between applications of each preparation.
OcularSideEffects
Transientstinging Transientblurring Photophobia Conjunctivalhyperaemia Conjunctivaloedema Raisedintraocularpressure
Hypersensitivity reactions may rarely occur, characterised by an allergic lid reaction, hyperaemiaandfollicularconjunctivitis.
GeneralSideEffects
Drymouth Dryskin Flushing Increasedbodytemperature Tachycardia CNSeffects
Anticholinergic effects e.g. dry mouth, flushing etc. are more likely to occur in infants and children. Contact dermatitis is not uncommon with atropine. CNS effects can occur, including:ataxia,hallucinationsanddrowsiness.
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Dose
Notrecommendedinchildren<3months. Adults&children(3monthsandover): For cycloplegic refraction: eyedrops, use 1 drop (1%) twice per day for 13 days before refraction.Forointment,useathinstrip3timesadayfor13daysbeforerefraction (donot useonthedayoftherefraction). Foruveitis:use1drop(1%)onceortwiceperday.
Storage
Storebelow25C.Protectfromlight.
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Azelastine Hydrochloride

LegalClassification
Optilast:eyedrops:0.05%azelastinehydrochloride(Meda)
DrugType
Antiinflammatory.
Classification
Antihistamine.
Indications
Licensedforthetreatmentofseasonalallergicconjunctivitisinadultsandchildren>4years, and the treatment of nonseasonal (perennial) allergic conjunctivitis in adults and children >12years. SeeClinicalManagementGuidelineonConjunctivitisseasonalandperennialallergic.
Contraindications
Hypersensitivitytoazelastineoranycomponentofthepreparation.
Cautions
Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. Animal studies have shown that high oral doses of azelastine induce adverse effects on the foetus and since there are no well controlled studies in pregnant women, azelastine should not to used in pregnancy. Azelastine is excreted into breastmilkinlowquantitiesandisthereforenotrecommendedduringlactation.
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allowatleast10minutesbetweenapplicationsofeachpreparation.
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OcularSideEffects
Transientirritation Transientstinging Transientburning Transientblurring
In controlled multidose studies, approximately 30% of patients experienced transient burning/stinging.Transientblurringisreportedbysmallnumbersofpatients.
GeneralSideEffects
Headache Bittertaste
In controlled trials 15% of subjects reported headache and 10% reported a bitter taste followingapplication.
Dose
Seasonal allergic conjunctivitis: adults & children (4 years and over), 1 drop applied twice dailyormorefrequently(uptofourtimesdaily)ifrequired. Perennial allergic conjunctivitis: adults & children (12 years and over), 1 drop applied twice dailyormorefrequently(uptofourtimesdaily)ifrequired. Maximumdurationoftreatmentis6weeks.
Storage
Storebelow25C.
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Carbomers

LegalClassification
P:Foruseandsupplybyalloptometrists. CE:Foruseandsupplybyalloptometrists.
P GelTears:gel,0.2%carbomer980(BauschandLomb) Liposic:gel,0.2%carbomer980(BauschandLomb) Liquivisc:gel,0.25%carbomer974P(SpectrumThea) LumecareLongLastingEyeGel,0.2%carbomer980(Medicom) Viscotears:liquidgel,0.2%carbomer980(Novartis) SingleUse(Preservativefree): ViscotearsSingleDose:liquidgel,0.2%carbomer980(Novartis) CE ClinitasHydrate:gel,0.2%carbomer980(Altacor)
DrugType
Artificialtears/Ocularlubricants.
Classification
Artificialtears.
Indications
Carbomers are synthetic high molecular weight polymers of acrylic acid used for the treatment of dry eye or an unstable tear film. See Clinical Management Guideline on Tear Deficiency.
Contraindications
Hypersensitivitytocarbomersoranycomponentofthepreparation.
Cautions
Multidose preparations contain preservatives (benzalkonium chloride or cetrimide) which may accumulate in soft contact lenses and cause irritation. Consider single use (unpreserved) preparations for soft lens wearers. Consult preservative tables for contact lenscompatibility.
26
Pregnancy risk category C. There are no adequate and wellcontrolled studies of carbomers in pregnant woman or lactation. Although the risk is low they cannot be recommended in pregnancyorlactation.
Interactions
OcularSideEffects
Transientblurring
GeneralSideEffects
None
Dose
Adults & children (1 month and over). Apply 1or 2 drops three to four times per day or as required.If>6dropsperdayconsideranonpreservedtearsupplement.
Storage
Storebelow25C.
27
Carmellose Sodium

LegalClassification
P SingleUse(Preservativefree) Celluvisc:eyedrops,1%carmellosesodium(Allergan) Celluvisc:eyedrops,0.5%carmellosesodium(Allergan) CE Optive:eyedrops,0.5%carmellosesodiuminglycerine(Allergen)
DrugType
Classification
Artificialtears.
Indications
Tear substitute for the treatment of dry eye. See Clinical Management Guideline on Tear Deficiency.
Contraindications
Hypersensitivitytocarmellosesodiumoranycomponentofthepreparation.
Cautions
None.
Pregnancy risk category C. There are no adequate and wellcontrolled studies of carmellose sodium in pregnancy or lactation. However, due to the negligible systemic exposure and the lack of pharmacological activity carmellose can be used during pregnancy and in nursing mothers.
28
Interactions
OcularSideEffects
Transientblurring
GeneralSideEffects
None
Dose
Adults&children(1monthandover).Apply1or2drops34timesperdayorasrequired.
Storage
Storebelow25C.
29
Cetirizine Hydrochloride

LegalClassification
P:Foruseandsupplybyalloptometrists. GSL:Foruseandsupplybyalloptometrists.
PandGSL(GSL,maximumpacksize,14tablets): BenadrylOneADayRelief:tablets,10mgcetirizinehydrochloride(McNeilProductsLtd) PiritezeAllergyTablets:tablets,10mgcetirizinehydrochloride(GSKConsumerHealthcare) ZirtekAllergyRelief:tablets,10mgcetirizinehydrochloride(UCBPharmaLtd) Preparationsforchildren: PandGSL: Benadryl Allergy Oral Syrup: oral solution,1mg/ml cetirizine hydrochloride (Mc Neil Products Ltd) BenadrylforChildrenAllergySolution:oralsolution,1mg/mlcetirizinehydrochloride(McNeil ProductsLtd) Piriteze Allergy Syrup: oral solution, 1mg/ml cetirizine hydrochloride (GSK Consumer Healthcare) ZirtekAllergySolution:oralsolution,1mg/mlcetirizinehydrochloride(UCBPharmaLtd)
DrugType
Antihistamine.
Classification
Indications
For the control of the symptoms of seasonal allergic rhinitis (hay fever) including ocular symptoms, perennial allergic rhinitis and other allergies e.g. insect bites, allergic skin reactions. SeeClinicalManagementGuidelineonConjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytocetirizineoranycomponentofthepreparation.
30
Cautions
Second generation antihistamines are less lipophilic and do not penetrate the bloodbrain barrier to any significant extent. They are therefore less likely to cause centrally mediated effects e.g. drowsiness. However, approx. 6% of patients experience such effects and therefore patients need to be warned that cetirizine may affect driving and other skilled tasks. Usewithcautioninpatientswithrenalorhepaticimpairment.
Pregnancy Category B: In animal studies, cetirizine was not teratogenic in doses many times higherthanthemaximumrecommendedhumandose.However,therearenoadequateand wellcontrolled studies in pregnant women and because animal studies are not always predictive of human response, cetirizine should be used in pregnancy only if clearly needed. Cetirizine has been reported to be excreted in human breast milk and therefore its use in nursingmothersisnotrecommended.
Interactions
Avoid excessive alcohol consumption. Anticholinergic effects of cetirizine (e.g. dry mouth, blurredvision) maybeenhancedbydrugswithanticholinergiceffectssuchas antipsychotics ortricyclicantidepressants.
OcularSideEffects
Blurredvision Dryeyes Oculogyriccrisis
Ocularsideeffectsareveryrare.
GeneralSideEffects
Drowsiness Fatigue Headache Dizziness Agitation Drymouth Gastointestinaldiscomfort
Generalsideeffectsarerareandaremorelikelytooccurinchildren.
31
Dose
Adults&children(12yearsandover):one10mgtabletdaily. Children6to11years:10ml(10mg)oncedailyor5mltwicedaily Children 2 to 5 years (licensed for seasonal allergic rhinitis only): 5ml (5mg) once daily or 2.5mltwicedaily.
Storage
Storebelow30C.
32
Chloramphenicol

LegalClassification
POM: For use and supply by all optometrists. May be used and prescribed by independent prescribingoptometrists. P:Foruseandsupplybyalloptometrists.
POM: Chloramphenicol:eyedrops,0.5%chloramphenicol(NonProprietary) Chloramphenicol:ointment,1.0%chloramphenicol(NonProprietary) ChloromycetinRedidrops:eyedrops,0.5%chloramphenicol(Goldshield) ChloromycetinOphthalmicOintment:1.0%chloramphenicolointment(Goldshield) SingleUse(Preservativefree): MinimsChloramphenicol:eyedrops,0.5%chloramphenicol(Bausch&Lomb) Overthecounter(P): BootsPharmacyAntibioticEyedrops:0.5%chloramphenicol(BootsCompanyPLC) BrochlorEyeDrops:0.5%chloramphenicol(SanofiAventis) BrochlorEyeOintment:1.0%chloramphenicol(SanofiAventis) GoldenEyeAntibiotic0.5%w/vChloramphenicolEyeDrops(Typharm) GoldenEye1%w/vChloramphenicolOintment(Typharm) GalpharmChloramphenicol0.5%w/vantibioticEyeDrops:(Galpharm) GalpharmAntibioticEyeOintment:(Galpharm) OptrexInfectedEyes:eyedrops,0.5%chloramphenicol(CrookesHealthcare) OptrexInfectedEyes:ointment,1.0%chloramphenicol(CrookesHealthcare)
Drugtype
Antiinfective.
Classification
Antibacterial.
Indications/Use
POM:Firstlinetopicaltreatmentforsuperficialocularinfectionsandasaprophylacticagent followingminoroculartrauma. P:Licensedforacutebacterialconjunctivitis.
See Clinical Management Guidelines on Hordeolum, Blepharitis, Conjunctivitis (Bacterial), Dacryocystitis(Chronic),CornealAbrasion,ForeignBody(Subtarsal).
33
Contraindications
Hypersensitivitytochloramphenicoloranycomponentofthepreparation. Previoushistoryorfamilyhistoryofblooddyscrasias.
Cautions
Contact lenses should not be worn during treatment. Multidose aqueous formulations contain phenylmercuric nitrate as a preservative, which may accumulate in soft lenses and causeirritation.
Pregnancy risk category C. There are no wellcontrolled studies of chloramphenicol in pregnant women and thus its safety for use in pregnancy has not been established. Chloramphenicol is excreted in human breast milk and therefore should therefore not be used in nursing mothers. Neonatal exposure to topical chloramphenicol carries a theoretical risk of grey baby syndrome (chloramphenicol toxicity in newborns resulting from the lack of liverenzymesnecessarytometabolizethedrug).
Interactions
Dose
POM:Adults&children(1monthandover). P:Adults&children(2yearsandover).Maximumdurationoftreatment5days. Eye drops: apply 1 drop into the infected eye every 2 hours for 48 hours. After this period, treatmentshouldbeevery4hoursduringwakinghours.Eyedropsmaybesupplementedby ointmentatnight.Thecourseoftreatmentshouldlast5days(evenifsymptomsimprove). Eyeointment:putasmallamountintotheaffectedeyefourtimesadayfor2days,andthen twiceadayfor5days.
OcularSideEffects
Transientirritation Transientstinging Transientblurring
Ocular side effects are rare. Transient irritation or stinging may occur on instillation. Ophthalmic ointment may cause blurring on application. Hypersensitivity reactions may rarelyoccur.
34
GeneralSideEffects
Aplasticanaemia.
GeneralSideEffectsNotes
Myelosupression following the use of topical chloramphenicol is not yet proven and the possibilityofidiosyncraticaplasticanaemiaarisingfollowingtreatmentisextremelyunlikely.
Storage
Storebetween2and8C.Protectfromlight.
35
Chlorphenamine Maleate

LegalClassification
Chlorphenamine:tablets,4mgchlorphenaminemaleate(Nonproprietary) PiritonAllergyTablets:tablets,4mgchlorphenaminemaleate(GSKConsumerHealthcare) Preparationsforchildren: Chlorphenamine:oralsolution,2mg/5mlchlorphenaminemaleate(Nonproprietary) PiritonSyrup:oralsolution,0.4mg/mlchlorphenaminemaleate(GSKConsumerHealthcare)
DrugType
Antihistamine.
Classification
Sedatingantihistamine.
Indications
For the control of the symptoms of seasonal allergic rhinitis (hay fever) including ocular symptoms, perennial allergic rhinitis and other allergies e.g. insect bites, allergic skin reactions. SeeClinicalManagementGuidelineonConjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytochlorphenamineoranycomponentofthepreparation.
Cautions
Drowsiness may affect performance in skilled tasks (e.g. driving). Children and the elderly are more likely to experience the neurological anticholinergic effects and paradoxical excitation(eg.Increasedenergy,restlessness,nervousness).
36
Pregnancy risk category B. There is inadequate evidence of the safety of chlorphenamine in human pregnancy. It should only be used when clearly needed and when the potential benefits outweigh the potential unknown risks to the foetus. It is reasonable to assume that chlorphenamine is secreted in breast milk and therefore use in nursing mothers requires thatthetherapeuticbenefitsoutweightthepotentialhazardstothebaby.
Interactions
Avoid excessive alcohol consumption. Anticholinergic effects of chlorphenamine (e.g. dry mouth, blurred vision) may be enhanced by drugs with anticholinergic effects such as antipsychotics, MAOI or tricyclic antidepressants. Chlorphenamine inhibits phenytoin metabolismandcanleadtophenytointoxicity. Concurrent use of chlorphenamine and hypnotics or anxiolytics may cause an increase in sedativeeffects.
OcularSideEffects
Blurredvision Dryeyes Mydriasis
Ocular side effects are rare and reversible when treatment is ceased. Prolonged use causes blurredvision,anisocoriaanddecreasedaccommodation.
GeneralSideEffects
Drowsiness Fatigue Headache Dizziness Psychomotorimpairment Drymouth Gastointestinaldisturbances
Generalsideeffectsarerareandaremorelikelytooccurinchildrenandtheelderly.
Dose
Adults & children (12 years and over): one 4mg tablet every 46 hours (max. dose 24mg in 24h) The elderly are more likely to experience neurological anticholinergic effects. Consideration shouldbegiventousingalowerdailydose(e.g.amaximumof12mginany24hours).
Childpreparations Childrenaged12years:2.5ml(1mg)twicedaily.Theminimum intervalbetweenthedoses shouldbe4hours.Maximumdailydose:5ml(2mg)inany24hours. Childrenaged26years: 2.5ml(1mg) every4to6 hourly.Maximum dailydose:15ml(6mg) inany24hours. Children6to11years:1x5mlor1/2tabletevery46hours(max.30mldaily)
37
Storage
Storebelow30C.
38
Cyclopentolate Hydrochloride

LegalClassification
POM:Foruseandsupplybyalloptometrists.
Mydrilate:eyedrops,0.5%cyclopentolatehydrochloride(Intrapharm) Mydrilate:eyedrops,1.0%cyclopentolatehydrochloride(Intrapharm) SingleUse(Preservativefree): MinimsCyclopentolate:eyedrops,0.5%cyclopentolatehydrochloride(Bausch&Lomb) MinimsCyclopentolate:eyedrops,1%cyclopentolatehydrochloride(Bausch&Lomb)
DrugType
Classification
Antimuscarinic.
Indications
Drug of choice for cycloplegic refraction. Also used for dilating the pupil in anterior uveitis, the alleviation of ciliary spasm following corneal abrasion and for penalisation therapy in amblyopia.SeeClinicalManagementGuidelinesonCornealAbrasionandAnteriorUveitis.
Contraindications
Hypersensitivitytocyclopentolateoranycomponentofthepreparation. Contraindicatedinpatientswithconfirmedorsuspectednarrowangleglaucomaasanacute attackmaybeprecipitated.
Cautions
Use with caution in very young children and other patients at particular risk, such as debilitated or aged patients. Darkly pigmented irises are more resistant to pupillary dilation and caution should be exercised to avoid overdosage. Systemic absorption may be reduced by compressing the lacrimal sac at the medial canthus during, and for 23 mins after instillationofthedrops. Multidose aqueous preparations contain benzalkonium chloride and should not be used whensoftcontactlensesareworn.
39
Pregnancy risk category C. There are no adequate and wellcontrolled studies of cyclopentolate in pregnant women. Cyclopentolate should not be used in pregnancy unless thebenefittothemotherclearlyoutweighstherisktothedevelopingfoetus.Itisnotknown whether cyclopentolate is excreted in breast milk. It should therefore be used with caution innursingmothers.
Interactions
The effect of antimuscarinic agents may be enhanced by the concomitant administration of other drugs with antimuscarinic properties such as amantadine, some antihistamines, butyrophenones,phenothiazinesandtricyclicantidepressants. In the case of concomitant use of another topical eye preparation, allow 510 minutes betweenapplicationsofeachpreparation.
OcularSideEffects
Transientstinging Transientblurring Photophobia Raisedintraocularpressure Conjunctivalhyperaemia Conjunctivaloedema
Hypersensitivity reactions may rarely occur. Sensitivity to light occurs secondary to pupillary dilation. Prolonged administration may lead to local irritation, hyperaemia, oedema and conjunctivitis.
GeneralSideEffects
CNSdisturbances Drymouth Flushing Tachycardia Urinarysymptoms Gastrointestinalsymptoms
Systemic cyclopentolate toxicity is doserelated. It is uncommon following administration of the 1% solution and would not be expected to occur following instillation of 0.5% solution. Children are, however, more susceptible to such reactions than adults. Toxicity is usually transient and is manifest mainly by CNS disturbances (ataxia, incoherent speech, restlessness,hallucinations,hyperactivity,disorientation).Systemicanticholinergictoxicityis arareconsequenceofsystemicabsorption.
40
Dose
Adultsandchildren(12yearsandover): For cyclopegic refraction: 1 drop of 0.5% solution (which may be repeated after five minutes)isusuallysufficient.Maximumeffectisinducedin3060minutesafterinstillation. For anterior & posterior uveitis and posterior synechiae breakdown: 1 2 drops (1%) are instilledevery68hours. Foralleviationofciliaryspasm:1drop(1%)23timesperday. Children: Notrecommendedinchildrenunder3months. Forcycloplegicrefraction:3months12years:1dropofa1%solutiontoeacheye. Childrenshouldbeobservedfor45minutesafterinstillation.
Storage
Storebelow25C.Protectfromlight. Mydrillateshouldbestoredbetween2and8C.
41
Diclofenac sodium

LegalClassification
VoltarolOphtha:eyedrops,0.1%diclofenacsodium(Novartis) Singleuse(preservativefree) VoltarolOphtha:eyedrops,0.1%diclofenacsodium(Novartis)
DrugType
Antiinflammatory.
Classification
Nonsteroidalantiinflammatory.
Indications
Reduction of peroperative miosis and postoperative inflammation. Control of pain following corneal epithelial defects. Seasonal allergic conjunctivitis. See Clinical Management GuidelinesonConjunctivitis(SeasonalandPerennial)andCornealAbrasion.
Contraindications
Hypersensitivitytodiclofenacsodiumoranycomponentofthepreparation.
Cautions
Use of topical NSAIDs may result in keratitis. In some susceptible patients continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal infiltrates, corneal erosion, corneal ulceration, and corneal perforation. These events may be sight threatening. Patients with evidence of corneal epithelial breakdown should immediately discontinueuseoftopicalNSAIDsandcornealhealthshouldbecloselymonitored. Caution should be exercised when topical NSAIDs are used concomitantly with topical steroids. Contact lens wear should be discontinued during treatment. The multidose preparation contains benzalkonium chloride as a preservative, which may accumulate in soft lenses and causeirritation.
42
Pregnancy risk category B. There are no data on the use of diclofenac eyedrops in pregnancy.Studiesinanimalshaveshownreproductivetoxicitywithdiclofenac.1stand2nd trimester: Animal studies to date have shown no risk to the foetus but no controlled studies inpregnantwomenareavailable.3rdtrimester:diclofenaceyedropsshouldnotbeuseddue to a possible risk of premature closure of the ductus arteriosus and possible inhibitions of contractions. Diclofenac is excreted in breast milk. However, at therapeutic doses of Voltarol Ophtha no effects on the suckling child are anticipated. Use of ocular diclofenac is not recommended duringbreastfeedingunlesstheexpectedbenefitsoutweighthepossiblerisks.
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allowatleast10minutesbetweeneachapplication.
OcularSideEffects
Transientburning Irritation Punctatekeratitis Raisedintraocularpressure Dryeyes Itching Hyperaemiaandblurringoninstillation
A mild to moderate burning sensation is the most frequently reported adverse reaction (15%). In high risk patients (corticosteroid use/rheumatic disease) diclofenac has been associated,inrarecases,withcornealulcerationorthinning.Mostpatientsweretreatedfor aprolongedperiodoftime.RaisedIOPhasalsobeennoted(usuallypostsurgery).
GeneralSideEffects
Abdominaldiscomfort Asthenia Dizziness Headaches Nausea Dyspnoea
Thefollowingsystemicadversereactionsoccurin3%orlessofthepatients:abdominalpain, asthenia, chills, dizziness, facial oedema, fever, headache, insomnia, nausea, pain, rhinitis, viralinfection,andvomiting. Inrarecasesdyspnoeaandexacerbationofasthmahavebeenreported.
43
Dose
Notlicensedforuseinchildren. Control of ocular pain associated with corneal epithelial defects after accidental non penetratingtrauma:apply1drop4timesdailyforupto2days. Thereliefoftheocularsignsandsymptomsofseasonalallergicconjunctivitis:apply1drop4 timesdailyforaslongasrequired.
Storage
Storebelow25C(multidose),28C(unitdose).Donotfreeze.
44
Doxycycline

LegalClassification
Doxycycline:capsules,50mgdoxycyclinehyclate(Nonproprietary) Doxycycline:capsules,100mgdoxycyclinehyclate(Nonproprietary) VibramycinD:dispersibletablets,100mgdoxycyclinemonohydrate(Pfizer) Modifiedrelease Efracea:capsules,40mgdoxycyclinemonohydrate(Galderma)
DrugType
Antiinfective.
Classification
Antibacterial.
Indications
Doxycycline has been found to be clinically effective in the treatment of a variety of infections caused by susceptible strains of Grampositive and Gramnegative bacteria and certainothermicroorganism.SeeClinicalManagementGuidelinesonBlepharitisandOcular Rosacea.
Contraindications
Hypersensitivity to doxycycline or component of the preparation. Hypersensitivity to any other members of the tetracycline family. Doxycycline is contraindicated in children less than12yearsofageandinpregnantornursingwomen.
Cautions
Use with caution in patients with hepatic impairment. May cause photosensitivity and patients should use skin protection, avoid prolonged exposure to sunlight and advised not use tanning equipment. A few cases of pregnancy have been attributed to the use of tetracycline antibiotics with oral contraceptives. Patients taking contraceptives containing oestrogenshouldbewarnedthatthereisapossibilityofcontraceptivefailureandadvisedto use alternative forms of contraception during treatment. Use with caution in patients with SLEormyastheniagravisastetracyclinesmayexacerbatetheseconditions.
45
Pregnancy risk category D: contraindicated in pregnancy. Animal studies have shown that tetracyclines cross the placenta and can cause toxicity to the foetus. Yellowbrown discolouration of the teeth and enamel hypoplasia can occur when drugs of the tetracycline family are administered after the first trimester of pregnancy. Tetracyclines are excreted intobreastmilkandthereforecontraindicatedinnursingmothers.
Interactions
Antacids and preparations containing aluminium, calcium, magnesium, zinc, bismuth or iron may decrease the absorption of doxycycline. Tetracyclines decrease plasma prothrombin activity and a dose reduction in patients taking anticoagulants may be necessary. Tetracyclines may reduce the effect of oral contraceptives (see cautions). Tetracyclines may increasetheplasmaconcentrationofcyclosporin.
OcularSideEffects
Blurredvision Fieldloss Diplopia Discolorationoftheconjunctivaandlacrimalsecretions
Ocular side effects are rare. Visual disturbance (blurred vision, field loss, diplopia) has been reportedinassociationwithbenignintracranialhypertension.
GeneralSideEffects
Gastrointestinaldisturbancese.g.nausea,vomitinganddiarrhoea Oesophagitisandoesophagealulceration Discolourationofteethandenamelhypoplasia(youngchildren) Abnormalbonegrowth(youngchildren) Hypersensitivityreactions Headache Photosensitivity Benignintracranialhypertension
Gastrointestinal disturbances are commonly reported. The presence of headache and visual disturbancemayindicatebenignintracranialhypertension(discontinuetreatment).
46
Dose
Forblepharitisandocularrosacea:treatmentmayneedtobecontinuedforseveralweeksor months. Adults:2x50mgcapsulesoncedaily(or1x100mgdaily).
Storage
Storebelow25C.
47
Emedastine

LegalClassification
Emadine:eyedrops,0.05%emedastine(asdifumarate)(Alcon)
DrugType
Antiinflammatory.
Classification
Antihistamine.
Indications.
Treatmentofseasonalallergicconjunctivitis. SeeClinicalManagementGuidelineonConjunctivitisseasonalandperennialallergic.
Contraindications.
Hypersensitivitytoemedastineoranycomponentofthepreparation.
Cautions.
Contact lenses should not be worn during treatment. Preparation contains benzalkonium chlorideasapreservative,whichmayaccumulateinsoftcontactlensesandcauseirritation.
PregnancyandLactation.
Pregnancy risk category B. Safety in pregnancy has not been established. Foetal toxicity has been reported in animals after oral doses many times higher than the ophthalmic dose. It is thereforerecommendedthatemedastineisnotusedduringpregnancy.Emedastinehasalso been detected in breast milk in animal studies and therefore this medicine should be avoidedinnursingmothers.
Interactions.
48
OcularSideEffects.
Transientirritation Dryeye Foreignbodysensation Conjunctivalhyperaemia Cornealinfiltrates
OcularSideEffectsNotes.
In controlled trials, ocular side effects were reported in 1418% of patients. Transient irritation on instillation is the most commonly reported side effect. Less common effects includedryeye,foreignbodysensation,conjunctivalhyperaemia(reportedinlessthan5%). Cornealinfiltrateshavebeenreportedinconjunctionwiththeuseofemedastine.
GeneralSideEffects.
Headache Rhinitis
GeneralSideEffectsNotes.
Occasional systemic adverse events are reported, including: headache (11%), rhinitis, cold syndrome,painandbackpain.
Dose.
Adults&children(3yearsandover),1dropappliedtwicedaily.
Storage.
Storebelow25C.
49
Epinastine Hydrochloride

LegalClassification
Relestat:eyedrops,0.5mgpermlepinastinehydrochloride(Allergan)
Drugtype
Antiinflammatory.
Classification
Antihistamine.
Indications/Use
Epinastine is indicated for the treatment of the symptoms of seasonal allergic conjunctivitis. SeeClinicalManagementGuidelineonConjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytoepinastineoranycomponentofthepreparation.
Cautions
Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. Data is limited on the safety of epinastine in pregnancy. Therefore, the use of epinastine during pregnancy requires that the benefits be weighed against the potential risks to the foetus. It is not known whether epinastine is excreted in human breast milk. Caution should be exercised when prescribing epinastine to breast feedingwomen.
Interactions
50
OcularSideEffects
Mildburningsensation Dryeye Conjunctivalhyperaemia Conjunctivaloedema Photophobia Visualdisturbance
Transient burningoninstillationiscommon,whereasothersideeffectsarerareanddifficult todifferentiatefromtheconditionforwhichthedrugisused.
GeneralSideeffects
Drymouth Tastedisturbance Nasalirritation Headache Itching
Generalsideeffectsareuncommon(<1:100).
Dose
Foradults&children(12yearsandover):onedropshouldbeinstilledintoeachaffectedeye twicedaily.Durationoftreatmentshouldnotexceed8weeks.
Storage
Storebelow25C.
51
Eye Nutrients

LegalClassification
Unlicensed:Foruseandsupplybyalloptometrists.
DrugType
Nutritionalsupplements.
Classification
Vitaminsandminerals.
PreparationsAvailable
Equavision:(Equazen) EyeEssentials:(VitaminHealth) ICaps:(Alcon) Macusan:(ButterfliesHealthcare) MacusanPlus:(ButterfliesHealthcare) Macushield:(MacuvisionEurope) NutrofTotal(SpectrumThea) OcuviteLutein:(BauschandLomb) OcuviteComplete:(BauschandLomb) PreserVisionOriginal:(BauschandLomb) PreserVisionLutein:(BauschandLomb) Visionace:(Vitabiotics) VisionacewithOmega3:(Vitabiotics) VisiViteOriginalFormula:(VitaminScience) VisiviteSmokersFormula:(VitaminScience) ViteyesAdvanced:(VitaminHealth) ViteyesAdvancedBetaCaroteneFree:(VitaminHealth) ViteyesOmega3:(VitaminHealth) ViteyesOriginal:(VitaminHealth) ViteyesOriginalPlusLutein:(VitaminHealth) ViteyesPlusLuteinBetaCaroteneFree:(VitaminHealth)
Indications
Maintenanceofeyehealth.Managementofpatientswithagerelatedmaculardegeneration (limited support for the use of certain nutritional supplements in the management of patients with ARMD is provided by the Agerelated Eye Disease Study (AREDS) http://www.nei.nih.gov/amd/summary.asp
52
Contraindications
Products containing betacarotene (as vitamin A) should not be used by past or current smokers(betacarotenehasbeenfoundtoincreasetheriskoflungcancerinsmokers). CoppershouldbeavoidedinpatientswithbiliarytractobstructionorWilsonsdisease.
Cautions
Therisksofhighdosenutritionalsupplementsareunknown. Vitamin E has been associated with an increased risk of heart failure in people with vascular diseaseordiabetes. HighdosesofvitaminAcanincreasetheriskofosteoporosisinwomen.
It is not advisable to take high dose multivitamins and minerals in pregnancy or during lactation.
Interactions
The anticoagulant properties of warfarin can be altered by high doses of vitamin A, C and E. Zinc decreases the absorption of tetracyclines and fluoroquinolones. Concurrent use of isotretinoinmayincreasetheriskofvitaminAtoxicity.
OcularSideEffects
Nonereported.
GeneralSideEffects
Nausea Gastrointestinaldisturbance
The Agerelated Eye Disease Study (AREDS) addressed the issue of safety of the preparation used. Yellowing of the skin and selfreported anaemia were noted slightly more often in patients taking multivitamins (with or without zinc) compared to placebo. There is little availabledataonthelongtermsafetyoftheseproducts,
Dose
Notrecommendedinchildren. DosingforindividualproductsisgivenintheTable.
Storage
Storebelow25C.
53
Fluorescein Sodium

LegalClassification
SingleUse(Preservativefree): Fluorets:paperstripsimpregnatedwithapproximately1mgofsodiumfluorescein(Chauvin) MinimsFluorescein:eyedrops,1%fluoresceinsodium(Chauvin) MinimsFluorescein:eyedrops,2%fluoresceinsodium(Chauvin)
DrugType
Oculardiagnosticpreparation.
Classification
Diagnosticstain.
Indications
As a diagnostic stain for the detection of lesions and foreign bodies. Fluorescein is also used forGoldmannapplanationtonometryandinthefittingofrigidcontactlenses.
Contraindications
Hypersensitivity to fluorescein or any component of the preparation. Fluorescein is able to penetratesoftcontactlensesandthereforeshouldnotbeusedwhensoftcontactlensesare worn.
Cautions
Special care should be taken to avoid microbial contamination. Pseudomonas aeruginosa growswellinfluoresceinsolutions.EachMinimsunitshouldbediscardedafterasingleuse.
Pregnancy risk category B. There are no adequate and wellcontrolled studies of fluorescein in pregnant woman. Animal studies have shown that fluorescein crosses the placental barrier. Fluorescein should therefore be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. Although fluorescein is excreted in breast milk it is generally considered safe to use in nursing mothers.
54
Interactions
Noneknown.
OcularSideEffects
Transientblurring.
GeneralSideEffects
None.
Dose
Adults&children(1monthandover).OneFluoretmoistenedwithtearfluid,sterilewateror sterile ophthalmic solution applied topically to the eye should be sufficient to provide adequate corneal staining. For eyedrops, a single drop of 1 or 2% sodium fluorescein is usuallysufficientformostindications.
Storage
Storebelow25C.
55
Fluorometholone

LegalClassification
FML:eyedrops,0.1%fluorometholone,1.4%PVA(Liquifilm)(Allergan)
Drugtype
Antiinflammatory.
Classification
Corticosteroid.
Indications/Use
Fluorometholone is indicated in the treatment of corticosteroidresponsive inflammation of the conjunctiva, cornea and anterior segment. See Clinical Management Guidelines on Pinguecula,PterygiumandEpiscleritis.
Contraindications
Hypersensitivitytofluorometholoneoranycomponentofthepreparation.Fluorometholone is contraindicated in viral diseases of the cornea and conjunctiva, fungal diseases of the eye orotherinfectiousdiseaseswhereitmaymaskinfectionorenhanceanexistinginfection.
Cautions
Fluorometholone, as with other corticosteroids, can cause ocular hypertension and should be used with caution in patients with glaucoma (see Clinical Management Guideline on SteroidGlaucoma). Prolonged use of corticosteroids may suppress host immune responses and increase the possibilityofsecondaryocularinfection. In diseases causing thinning of the cornea or sclera, corticosteroids have been associated withperforations. Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmaybeaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. Safety of fluorometholone during pregnancy has not been established. Therefore, the use of fluorometholone during pregnancy requires that the
benefits be weighed against the potential risks to the foetus. It is not known if fluorometholone is excreted in human breast milk. Caution should be exercised when prescribingtobreastfeedingwomen.
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Interactions
OcularSideEffects
Raisedintraocularpressure Posteriorsubcapsularcataractformation Secondaryocularinfection Perforationoftheglobe
The likelihood of ocular hypertension is reduced compared to other corticosteroids e.g. prednisolone. Ocular signs and symptoms similar to the underlying ocular disease being treated were reported in clinical trials e.g. ocular discomfort, epiphora, foreign body sensation,hyperaemiaanditching.
GeneralSideeffects
Local side effects of steroid therapy e.g. skin atrophy, striae and telangiectasia may affect facialskin.
Dose
Foradults&children(2yearsandover):12dropsshouldbeinstilled24timesdaily.During theinitial2448hoursthedosecanbeincreasedto2dropseveryhour.
Storage
Storebelow25C.
57
Flurbiprofen

LegalClassification
Flurbiprofen:tablets,50mgflurbiprofen(Nonproprietary) Flurbiprofen:tablets,100mgflurbiprofen(Nonproprietary) Froben:tablets,50mgflurbiprofen(Abbott) Froben:tablets,100mgflurbiprofen(Abbott) Modifiedrelease FrobenSR:tablets,200mgflurbiprofen(Abbott)
DrugType
Antiinflammatory.
Classification
Nonsteroidalantiinflammatorydrug(NSAID).
Indications
Flurbiprofen is licensed for the treatment of inflammatory musculoskeletal and joint diseases. It is also licensed for the relief of mild to moderate pain. Flurbiprofen has been used off licence for the treatment of inflammatory diseases of the anterior eye. See Clinical ManagementGuidelineonEpiscleritis.
Contraindications
Hypersensitivity to flurbiprofen or any component of the preparation. There is the potential of cross sensitization with aspirin or other NSAIDs and flurbiprofen is not indicated in individualswhohavepreviouslydemonstratedsensitivitytothesedrugs.Flurbiprofenshould not be used in patients with a history of gastrointestinal bleeding or perforation, patients with ulcerative colitis or Crohns disease or in patients with severe heart failure, hepatic failureorrenalfailure.
Cautions
The elderly are at increased risk of NSAIDinduced adverse reactions. Particular caution is required in patients with renal, cardiac or hepatic impairment. The dose should be the lowest effective dose for the shortest duration. Caution is required if flurbiprofen is
administered to patients suffering from or with a previous history of asthma or bleeding disorders.
58
PregnancyriskcategoryC. There havebeenreportsofNSAID toxicityduring the earlystages of pregnancy in animal studies. In the third trimester, flurbiprofen can expose the foetus to cardiopulmonary toxicity and renal dysfunction. Most manufacturers therefore recommend that flurbiprofen should not be used during pregnancy. NSAIDs pass into breast milk in very lowlevelsandshouldbeavoidedinnursingmothers.
Interactions
Should not be used with other NSAIDs. NSAIDs potentiate the anticoagulant effect of warfarin. NSAIDs reduce the effects of diuretics and other antihypertensive drugs. NSAIDs canincreasetheriskofconvulsionswithquinoloneantibiotics.
OcularSideEffects
Nonspecificvisualdisturbance.
Ocularsideeffectsarerareandhavegenerallybeendescribedinpatientstakinghighdoses.
GeneralSideEffects
Abdominalpain,nauseaanddyspepsia Pepticulcerandgastrointestinalhaemorrhage. Hypersensitivityreactions Oedema,hypertensionandcardiacfailure
Gastrointestinaldisordersarethemostcommonlyreportedsideeffects.
Dose
Forthetreatmentofepiscleritis Adults & children (12 years and over): 100mg daily in 2 divided doses with or after food. Totaldailydosemayincreaseto300mgindivideddoses.
Storage
Storebelow25C.
59
Flurbiprofen Sodium

LegalClassification
POM:Maybeusedandprescribedbyoptometristindependentprescribers.
Ocufen:eyedrops,singledoseunitscontaining0.03%flurbiprofensodium(Allergan)
Drugtype
Antiinflammatory.
Classification
Indications/Use
Flurbiprofen is indicated for the inhibition of intraoperative miosis and reduction of inflammation following ocular surgery. It is also used offlicence for the treatment of inflammatory disorders of the anterior segment. See Clinical Management Guideline on Episcleritis.
Contraindications
Hypersensitivity to flurbiprofen or any component of the preparation. There is the potential of cross sensitization with aspirin or other NSAIDs and flurbiprofen is not indicated in individualswhohavepreviouslydemonstratedsensitivitytothesedrugs.
Cautions
Flurbiprofen should be used with caution in patients with known bleeding tendencies or patients with a history of peptic ulceration. Wound healing may be delayed with flurbiprofen.
PregnancyriskcategoryC.Safetyofflurbiprofenduringpregnancyhasnotbeenestablished. Therefore, the use of flurbiprofen during pregnancy requires that the benefits be weighed againstthepotentialriskstothefoetus.Flurbiprofenisexcretedinhumanbreastmilkatlow levels.Cautionshouldbeexercisedwhenprescribingtobreastfeedingwomen.
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Interactions
OcularSideEffects
Transientburningandsingingoninstillation
Transientburningoninstillationisverycommon.
GeneralSideeffects
Headache
Dose
Adults: one drop should be instilled 4 times daily for at least a week. Not licensed for use in children.
Storage
Storebelow25C.
61
Fusidic acid

LegalClassification
POM: Foruseandsupply byalloptometrists.May be prescribedbyindependentprescribing optometrists.
Fucithalmic:viscousgel,1%fusidicacid(Leo)
Drugtype
Antiinfective.
Classification
Antibacterial.
Indications/Use
Fusidic acid is indicated for the topical treatment of bacterial conjunctivitis where the organism is known to be sensitive to the antibiotic. Fusidic acid is particularly active against staphylococcusorganisms.SeeClinicalManagementGuidelineonConjunctivitis(Bacterial).
Contraindications
Hypersensitivitytofusidicacidoranycomponentofthepreparation.
Cautions
Should be used as second line therapy for bacterial conjunctivitis due to the risk of developingstaphylococcalresistance. Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. Limited clinical data on exposed pregnancies is available, and animal studies and many years of clinical experience with systemic and topical fusidic acid suggest that fusidic acid is devoid of teratogenic effect. Consequently any risk to the foetus is unlikely using the very low doses of fusidic acid applied topically in an ophthalmic preparation.Canbeadministeredduringpregnancyifconsiderednecessary. No effects on the infant are anticipated since the systemic exposure of the breastfeeding womantofusidicacidisnegligible.Topicalfusidicacidcanbeusedduringbreastfeeding.
62
Interactions
OcularSideEffects
Transientburning Transientstinging Transientblurring
Transient itching, burning and stinging after application (in approx. 3% of patients). Hypersensitivity reactions may rarely occur characterized by urticaria (localized or generalized).
GeneralSideeffects
Nonereported.
Dose
For adults & children (1 month and over): One drop to be instilled into the eye twice daily. Treatmentshouldbecontinuedforatleast48hoursaftertheeyereturnstonormal.
Storage
Storebelow25C.
63
Homatropine Hydrobromide

LegalClassification
Homatropine:eyedrops,1%homatropinehydrobromide(nonproprietary)
DrugType
Classification
Antimuscarinic.
Indications
Cycloplegic refraction. Also used for dilating the pupil in anterior uveitis, the alleviation of ciliary spasm following corneal abrasion and for penalisation therapy in amblyopia. See ClinicalManagementGuidelinesonCornealAbrasionandAnteriorUveitis.
Contraindications
Hypersensitivitytohomatropineoranycomponentofthepreparation. Contraindicatedinpatientswithconfirmedorsuspectednarrowangleglaucomaasanacute attackmaybeprecipitated.
Cautions
Use with caution in patients at risk of systemic effects e.g. neonates, debilitated or elderly patients or patients with Downs Syndrome. Children with brain damage may also demonstrate a hyperreactive response to homatropine. Systemic absorption may be reducedbycompressingthelacrimalsacatthemedialcanthusduring,andfor23minsafter instillation. Softcontactlensesshouldnotbewornduringtreatment.Containsbenzalkoniumchlorideas apreservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. Safety of homatropine for use in pregnancy has not been established. Homatropine passes into breast milk in small amounts and may cause anti cholinergiceffectsinbabiesofnursingmothers.
64
Interactions
The effect of antimuscarinic agents may be enhanced by the concomitant administration of other drugs with antimuscarinic properties such as amantadine, some antihistamines, butyrophenones, phenothiazines and tricyclic antidepressants. In the case of concomitant use of another topical eye preparation, allow 510 minutes between applications of each preparation.
OcularSideEffects
Transientstinging Transientblurring Photophobia Conjunctivalhyperaemia Conjunctivaloedema Raisedintraocularpressure
Hypersensitivity reactions may rarely occur, characterised by an allergic lid reaction, hyperaemiaandfollicularconjunctivitis.
GeneralSideEffects
Drymouth Dryskin Flushing Increasedbodytemperature Tachycardia CNSeffects
Anticholinergic effects e.g. dry mouth, flushing etc. are more likely to occur in infants and children, although reduced likelihood compared to atropine. CNS effects are rare (restlessness,hallucinations).
Dose
Notrecommendedinchildren<3months.
Adults&children(3monthsandover): Forcycloplegicrefraction:use1drop2timesperdayfor13daysbeforerefraction. Foruveitis:use1drop12timesperday. Foralleviationofciliaryspasm:use1dropevery34hours.
65
Storage
66
Sodium Hyaluronate

LegalClassification
CE:Foruseandsupplybyalloptometrists.
AvizorMoistureDrops:0.1%sodiumhyaluronate(Avizor) AquifyComfortDrops:eyedrops,5%sodiumhyaluronate(CIBAVision) BlinkContacts:eyedrops,0.15%sodiumhyaluronate(AMO) BlinkIntensiveTears:eyedrops,0.2%sodiumhyaluronate,0.25%PEG400(AMO) OptrexDryEyeDrops:eyedrops,0.15%sodiumhyaluronate(CrookesHealthcare) Oxyal:eyedrops,0.15%sodiumhyaluronate(Kestrel) Rohto Dry Eyes Relief: eyedrops, 0.2% Hyaluronic Acid & Tamarind Seed Polysaccharide (Metholatum) VismedLight:0.1%sodiumhyaluronate(TRBChemica) Multidose(Preservativefreeeyedrops): Hyabak:0.15%sodiumhyaluronate(SpectrumThea) Hycosan:0.1%sodiumhyaluronate(Bausch&Lomb) Hycosan Plus: 0.1% Sodium Hyaluronate & 2.0% Dexapanthenol (Vitamin B5) (Bausch & Lomb) HyloTear:0.1%sodiumhyaluronate(ScopeOphthalmics) HyloForte:0.2%sodiumhyaluronate(ScopeOphthalmics) LumecareExtraGentleTearDrops:0.15%sodiumhyaluronate(Lumecare) VismedMulti:0.18%sodiumhyaluronate(TRBChemica) SingleUse(Preservativefree): AvizorMoistureDrops:0.1%sodiumhyaluronate(Avizor) BlinkContacts:eyedrops,0.15%sodiumhyaluronate(AMO) BlinkIntensiveTears:eyedrops,0.2%sodiumhyaluronate,0.25%PEG400(AMO) ClinitasSoothe:eyedrops,0.4%sodiumhyaluronate(Altacor) Hyaldrop:eyedrops,0.2%sodiumhyaluronate(Bausch&Lomb) Libristil:eyedrops,0.15%sodiumhyaluronate(MoorfieldsPharmaceuticals) Ocusan:eyedrops,0.2%sodiumhyaluronate(Agepha) OptrexDryEyeDropsSingles:0.2%sodiumhylauronate(CrookesHealthcare) Rohto Dry Eyes Relief: eyedrops, 0.2% Hyaluronic Acid & Tamarind Seed Polysaccharide (Metholatum) Vismed::eyedrops,0.3%sodiumhyaluronate(TRBChemica) VismedSingleDose:eyedrops,0.18%sodiumhyaluronate(TRBChemica) Vislube:eyedrops,0.18%sodiumhyaluronate(TRBChemica)
DrugType
67
Classification
Artificialtears.
Indications
Contraindications
Hypersensitivitytosodiumhyaluronateoranycomponentofthepreparation.
Cautions
Some multidose preparations contain preservatives (benzalkonium chloride or cetrimide) which may accumulate in soft contact lenses and cause irritation. Consider single use (unpreserved) preparations in soft lens wearers. Consult preservative tables for contact lens compatibility.
Pregnancy risk category C. Although there are no adequate and wellcontrolled studies of hyaluronic acid in pregnancy or lactation, hyaluronic acid is a natural product and therefore nospecialprecautionsarerequiredforitsuseinpregnancyandlactation.
Interactions
OcularSideEffects
Transientblurring Transientirritation
There have been case reports of deep calcium deposition in the cornea in patients with ocular surface disorders and prolonged use of multidose preparations containing high phosphatelevels.
GeneralSideEffects
None
Dose
Adults & children (12 years and over). Apply 1 or 2 drops three to four times per day or as required.
68
Storage
Storebelow25C.
69
Hydroxyethylcellulose

LegalClassification
SingleUse(Preservativefree): MinimsArtificialTears:eyedrops,0.44%hydroxyethylcellulose(Bausch&Lomb)
DrugType
Classification
Artificialtears.
Indications
Contraindications
Hypersensitivitytohydroxyethylcelluloseoranycomponentofthepreparation.
Cautions
None.
Pregnancy risk category C. There are no adequate and wellcontrolled studies of hydroxyethylcellulose in pregnant woman. However, topical application is not thought to poseasignificantrisk.Similarly,thepossibilityofsecretionintobreastmilkislow.
Interactions
70
OcularSideEffects
Transientblurring
GeneralSideEffects
None
Dose
Adults & children (12 years and over). Apply 1 or 2 drops three to four times per day or as required.
Storage
Storebelow25C.
71
Hypromellose

LegalClassification
P:Foruseandsupplybyalloptometrists. CE:Foruseandsupplybyalloptometrists
P Hypromellose:eyedrops,0.3%hypromellose(Nonproprietary) Artelac:eyedrops,0.32%hypromellose,0.1%dextran70(PharmaGlobal)) IsoptoAlkaline:eyedrops,1%hypromellose(Alcon) IsoptoPlain:eyedrops,0.5%hypromellose(Alcon) TearsNaturale:eyedrops,0.3%hypromellose,0.1%dextran70(Alcon) SingleUse(Preservativefree): Hypromellose:eyedrops,0.3%hypromellose(Nonproprietary) ArtelacSDU:eyedrops,0.32%hypromellose(PharmaGlobal) TearsNaturaleSingleDose:eyedrops,0.3%hypromellose,0.1%dextran70(Alcon) CE SingleUse(Preservativefree): Hydromoor:eyedrops,0.3%hypromellose(MoorfieldsPharmaceuticals) LumecarePreservativeFreeTearDrops:eyedrops,0.3%hypromellose(Medicom)
DrugType
Artificialtears/Ocularlubricants.SeeClinicalManagementGuidelineonTearDeficiency.
Classification
Artificialtears.
Indications
Tearsubstituteforthetreatmentofdryeye.
Contraindications
Hypersensitivitytohypromelloseoranycomponentofthepreparation.
72
Cautions
Multidose preparations contain benzalkonium chloride as a preservative, which may accumulate in soft contact lenses and cause irritation. Consider single use (unpreserved) preparationsinsoftlenswearers.Consultpreservativetablesforcontactlenscompatibility.
Pregnancy risk category C. There are no adequate and wellcontrolled studies of hypromellose in pregnant woman or lactation. Hypromellose should be used with caution in pregnant or nursing mothers, and only if the expected benefit is greater than any possible risktothedevelopingfoetusorbaby.
Interactions
OcularSideEffects
Transientblurring Transientstinging
GeneralSideEffects
None
Dose
Adults & children (1 month and over). Apply 1 or 2 drops three to four times per day or as required.
Storage
Storebelow25C.
73
Ibuprofen

LegalClassification
POM: Ibuprofen: tablets, 200, 400, 600mg ibuprofen (Nonproprietary) Brufen: tablets, 200, 400, 600mg ibuprofen (Abbott) Ibuprofen:oralsuspension,100mgibuprofenper5mldose(Nonproprietary) PandGSL(GSLcontainnomorethan16tablets): Ibuprofen:tablets,200mgibuprofen(Nonproprietary) Ibuprofen:tablets,400mgibuprofen(Nonproprietary) AnadinIbuprofen:tablets,200mgibuprofen(WyethConsumerHealthcare) AnadinUltraDoubleStrength:tablets,400mg(WyethConsumerHealthcare) Cuprofen:tablets,200mgibuprofen(SSLInternational) CuprofenMaximumStrength:tablets400mgibuprofen Nurofen:tablets,200mgibuprofen(CrookesHealthcareLtd) Combinationproducts: CuprofenPlus:tablets,200mgibuprofenand12.8mgcodeinephosphate(SSLInternational) NurofenPlus:tablets,200mgibuprofenand12.8mg codeinephosphate(CrookesHealthcare Ltd) Preparationsforchildren: PandGSL(GSLnomorethan100ml): Calprofen Ibuprofen Suspension : oral suspension, 100mg ibuprofen per 5ml dose (Mc Neil ProductsLtd) CuprofenforChildren:100mgibuprofenper5mldose(SSLInternational) NurofenforChildren:oralsuspension,100mgibuprofenper5mldose(CrookesHealthcare)
DrugType
Classification
Nonsteroidalantiinflammatoryanalgesic.
74
Indications
Mildtomoderatepainfromavarietyofcauses.
Contraindications
Ibuprofen should be avoided in patients with gastric ulcers or a history of gastric problems and patients with a history of bronchospasm, rhinitis, urticaria, particularly associated with therapywithaspirinorothernonsteroidalantiinflammatorydrugs.
Cautions
The elderly are at increased risk of NSAIDinduced adverse reactions. Particular caution is requiredinpatientswithrenalorhepaticimpairment.Thedoseshouldbeaslowaspossible.
Pregnancy risk category B. Most manufacturers recommend that ibuprofen should not be used during pregnancy. Ibuprofen passes into breast milk in very low levels less than 0.6% of the maternal dose. It is also frequently given directly to infants to reduce fever. It is thereforeconsideredsafetobeusedinnursingmothers.
Interactions
Should not be used with other NSAIDs. Should be used with caution in patients taking anticoagulants,diuretics,antihypertensives,lithium,methotrexateorzidovudine.
OcularSideEffects
Transientblurring Refractivechanges Diplopia Dryeyes Photophobia Colourvisiondisturbances
Ocular side effects are rare. Transient blurred vision is the most common side effect. Other well documented adverse reactions include: refractive changes, diplopia, dry eyes, photophobiaandcolourvisiondisturbances.
GeneralSideEffects
Abdominalpain,nauseaanddyspepsia Pepticulcerandgastrointestinalhaemorrhage. Thrombocytopenia. Headache Dizziness Hearingdisturbance.
75
Dyspepsia is relatively common. Other side effects are rare. Hypersensitivity reactions have been reported following treatment with ibuprofen. These may consist of (a) nonspecific allergic reactions and anaphylaxis, (b) respiratory tract reactivity e.g. aggravating asthma, bronchospasmordyspnoea,or(c)assortedskindisorders,includingrashesofvarioustypes.
Dose
Adults&children(12yearsandover):Initialdose2x200mgtablets,thenifnecessary,1or2 tabletsevery4hours(withorafterfood).Donotexceed6tabletsdaily(1200mg). Childpreparations: Infants36months:one2.5mldosemaybetaken3timesin24hours. Infants612months:one2.5mldosemaybetaken34timesin24hours. Children13years:one5mldosemaybetaken3timesin24hours. Children46years:one7.5ml(5ml+2.5ml)dosemaybetaken3timesin24hours. Children712years:one10mldose(2x5ml)maybetaken3timesin24hours.
Storage
Storebelow25C.
76
Ketorolac Trometamol

LegalClassification
Acular:eyedrops,0.5%ketorolacsodium(Allergan)
Drugtype
Antiinflammatory.
Classification
Indications/Use
Ketorolac is indicated for the prophylaxis and reduction of inflammation following ocular surgery. It is also used offlicence for the treatment of inflammatory disorders of the anterior segment. See Clinical Management Guidelines on Pinguecula, Pterygium and Episcleritis.
Contraindications
Hypersensitivitytoketorolacoranycomponentofthepreparation. Topical NSAIDs should be used with caution in patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g. dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time, as they may be at increased risk for corneal adverse events which may becomesightthreatening. There is the potential of cross sensitization to aspirin or other NSAIDs and ketorolac is not indicatedinindividualswhohavepreviouslydemonstratedsensitivitytothesedrugs.
Cautions
Ketorolac should be used with caution in patients with known bleeding tendencies or patients with a history of peptic ulceration. Concomitant use of ketorolac and corticosteroids should be avoided in patients susceptible to corneal epithelial breakdown. Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
77
PregnancyriskcategoryC.Dataislimitedonthesafetyofketorolacinpregnancy.Therefore, the use of ketorolac during pregnancy requires that the benefits be weighed against the potential risks to the foetus. Ketoroloc is excreted in human breast milk at low levels. Cautionshouldbeexercisedwhenprescribingtobreastfeedingwomen.
Interactions
OcularSideEffects
Ocularirritationorburning Superficialpunctuatekeratitis Eyepainorstinging Eyelid/conjunctivaloedema Conjunctival/ocularhyperaemia Itching Hypersensitivityreactions Blurredvision Cornealinfiltrates Dryeye Increasedlacrimation
Transient burning on instillation is very common, eye pain, lid/conjunctival oedema, itching and ocular hyperaemia are common, whereas other side effects are rare. Postmarketing reports of corneal damage with topical NSAIDs have been received, although generally in eyes receiving corticosteroids and with predisposing ocular morbidity.These events may be sight threatening. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs and should be closely monitored for corneal health.
GeneralSideeffects
Headache
Dose
Adults: one drop should be instilled 3 times daily for up to 3 weeks. Not licensed for use in children.
Storage
Storebelow25C.
78
Ketotifen

LegalClassification
Zaditen:eyedrops,250micrograms/mlketotifen(asfumarate)(Novartis)
DrugType
Antiinflammatory.
Classification
Antihistamine.
Indications
Treatment of seasonal allergic conjunctivitis. See Clinical Management Guideline on Conjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytoketotifenoranycomponentofthepreparation.
Cautions
Contact lenses should not be worn during treatment. Preparation contains benzalkonium chlorideasapreservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. There are no adequate and wellcontrolled studies in pregnant woman. Should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus or baby. Ketotifen has been identified in breast milk of animals following oral administration, however topical administration to humans is unlikely to produce detectable quantities in breast milk and thereforeketotifencanbeusedinnursingmothers.
79
Interactions
The use of systemic forms of ketotifen may potentiate the effect of CNS depressants, antihistamines and alcohol. Although this has not been observed with ketotifen eye drops, thepossibilityofsucheffectscannotbeexcluded. In the case of concomitant use of another topical eye preparation, allow 510 minutes betweeneachapplicationsofeachpreparation.
OcularSideEffects
Transientburning Transientstinging Transientblurring Punctatekeratitis Pain Dryeyes Hypersensitivityreactions
Ocular adverse reactions are rare. Transient irritation and punctate keratitis occurs in 12%. Otheradversereactionsoccurin<1%.
GeneralSideEffects
Headaches Rhinitis Rashes Somnolence
Generalsideeffectsarerare(<1%).
Dose
Adult&children(3yearsandover),apply1droptwicedaily.
Storage
Storebelow25C.
80
Levocabastine
TherearecurrentlynopreparationscommerciallyavailableintheUKforthisdrug.
81
Lid Care Products

LegalClassification
Blephasol:solution(preservativefree)(SpectrumThea) Blephaclean:sterilelidcleaningpads(SpectrumThea) LidCare:solution(Ciba) LidCare:sterilelidcleaningpads(Ciba) Supranettes:sterilelidcleaningpads(Alcon)
DrugType
LidCareProducts
Classification
LidCareProducts
Indications
Eyelidmarginhygienee.g.inthemanagementofblepharitis SeeClinicalManagementGuidelineonBlepharitis.
Contraindications
Hypersensitivitytoanycomponentofthepreparation.
Cautions
Donotinstillsolutionsdirectlyintotheeyes
Pregnancy risk category C. There are no adequate and wellcontrolled studies of the components oflidcareproductsinpregnantwomanorlactation.However,thereisminimal riskofsystemicabsorptionduringnormalexternaluseoflidcareproducts.
Interactions
Therearenoreportedinteractions.
82
OcularSideEffects
Transientstinging
GeneralSideEffects
None
Dose
Adults & children (1 month and over). Rub cleaning pad/ wipe several times over the eyelid marginstoremoveanydebris.Useafreshpad/wipeforeacheye.
Storage
Storebelow25C.
83
Lidocaine Hydrochloride (Lignocaine)

LegalClassification
POM:Forusebyalloptometrists.
SingleUse(Preservativefree) Minims Lidocaine and Fluorescein: eyedrops, 4% lidocaine hydrochloride, 0.25% fluorescein (Bausch&Lomb)
DrugType
Localanaesthetic.
Classification
Amidetypelocalanaesthetic.
Indications
Lidocainecombinedwithfluoresceinisusedforthemeasurementofintraocularpressureby Goldmannapplanationtonometry.
Contraindications
Hypersensitivitytolidocaineorfluorescein.
Cautions
The eye should be protected from foreign bodies and rubbing during the period of anaesthesia (up to 30 minutes). Ideally, the patient should not leave the practice until cornealsensationhasreturned.
Pregnancy risk category B. No well controlled clinical trials have been conducted in pregnancy and lactation. However, this combination has been used for many years without apparentilleffects.
Interactions
Nonereported.
84
OcularSideEffects
Transientstinging Transientblurring Punctatekeratitis
Hypersensitivity reactions may rarely occur, characterised by allergic conjunctivitis and peri orbitaloedema.
GeneralSideEffects
Noreportedgeneralsideeffects.
Dose
Adults & children (3 months and over). One drop is sufficient to anaesthetise the surface of theeyetoallowtonometryafteroneminute.
Storage
85
Liquid Paraffin

LegalClassification
LacriLube: eye ointment, 57.3% white soft paraffin, 42.5% liquid paraffin, 0.2% wool fat derivatives(Allergan)
DrugType
Classification
Ocularlubricant.
Indications
Lubrication and protection of the eye in conditions such as exposure keratitis, decreased corneal sensitivity, recurrent corneal erosions and keratoconjunctivitis sicca. See Clinical Management Guidelines on Tear Deficiency, Recurrent Corneal Erosion, Ectropion, Entropion,Trichiasis,FacialPalsy.
Contraindications
Hypersensitivitytoliquidparaffinoranycomponentofthepreparation.
Cautions
Contactlensesshouldberemovedpriortoinstillationandshouldnotbeinsertedforatleast 30minutes.
Pregnancy risk category C.The constituents of the available preparations have been used as pharmaceutical agents for many years with no untoward effects. No special precautions are thereforenecessaryfortheiruseinpregnancyorlactation.
Interactions
86
OcularSideEffects
Transient blurring lasting 115 minutes occurs following instillation. Hypersensitivy reactions canrarelyoccur.
GeneralSideEffects
None
Dose
Adults & children (1 month and over). Apply a small amount to the affected eye(s) as required.
Storage
Storebelow25C.
87
Lissamine Green

LegalClassification
LissamineGreenOphthalmicStrips:1.5mgLissamineGreenperstrip(Cyanacon/Ocusoft)
DrugType
Classification
Diagnosticstain.
Indications
Asadiagnosticstain.LissamineGreenstainsthesamedegeneratedconjunctivalandcorneal epithelialcellsasrosebengalandcanbeconsideredasubstituteinclinicalpractice.
Contraindications
Hypersensitivity to lissamine green or any component of the preparation. Do not use with softcontactlenses.
Cautions
None
Pregnancy risk category C. In the absence of any teratology studies, lissamine green is not recommended in pregnancy unless the therapeutic benefit exceeds the potential risk. It is not known whether lissamine green is secreted in breast milk. Therefore use with caution in nursingmothers.
Interactions
Noneknown.
OcularSideEffects
Transientblurring
Transientstinging
88
Stainingoftheeyelidsinthecaseofoverspilltearingfollowingapplication.
GeneralSideEffects
None
Dose
Adults & children. Moisten the lissamine green paper strip using 1 or 2 drops of sterile saline.Shakeoffexcessfluidandapplytotheconjunctivalsac.Askthepatienttoblinkafew times.
Storage
Storebelow25C.
89
Lodoxamide

LegalClassification
POM:Foruseandsupply byadditional supplyoptometrists. Maybeusedandprescribedby optometristindependentprescribers. P:Foruseandsupplybyalloptometrists.
POM: Alomide:eyedrops,0.1%lodoxamide(astrometamol)(Alcon) P: AlomideAllergy:eyedrops,0.1%lodoxamide(Alcon)
Indications
Treatment of allergic conjunctivitis. See Clinical See Clinical Management Guidelines on Atopic keratoconjunctivitis, Vernal keratoconjunctivitis, Conjunctivitis (Acute allergic), Conjunctivitis seasonal and perennial allergic and Contact lensassociated papillary conjunctivitis.
Drugtype
Antiinflammatory.
Classification
Mastcellstabilizer.
Contraindications
Hypersensitivitytolodoxamideoranycomponentofthepreparation.
Cautions
Pregnancy risk category B. Reproduction studies with lodoxamide administered orally to animals in doses of many times greater than the ophthalmic dose produced no evidence of foetal toxicity. However, there are no adequate and wellcontrolled studies in pregnant women. Lodoxamide should therefore be used during pregnancy only if clearly needed. It is
not known whether lodoxamide is secreted in human milk and caution should be exercised whenlodoxamideisadministeredtonursingmothers.
90
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allow510minutesbetweeneachapplicationsofeachpreparation.
OcularSideEffects
Transientburning Transientstinging Blurredvision Lidmargincrusting Conjunctivalhyperaemia Itching Tearing
Transient burning/stinging on instillation occurs in approx.13% of patients. Other adverse events occur in 15% of patients and are often difficult to distinguish from the symptoms of allergicconjunctivitis.
GeneralSideEffects
Headaches Dizziness Nausea Stomachdiscomfort Flushing
Headachesreportedin12%ofpatients.Othersystemicsideeffectsarerare(<1%).
Dose
Adults & children (4 years and over), apply 1 drop four times daily. Full effect may take severaldaystooccur.
Storage.
Storebelow25C.
91
Loratadine
LegalClassification
P:Foruseandsupplybyalloptometrists. GSL:Foruseandsupplybyalloptometrists.
PandGSL(GSL,packsize7tabletsorless): Loratidine:tablets,10mgloratidine(Nonproprietary) BootsNonDrowsyHayfeverandAllergyRelief:10mgloratidine(BootsCompanyPLC) BootsHayfeverReliefAllDay:1mg/ml0mgloratidine(BootsCompanyPLC) ClarytynAllergy:tablets,10mgloratidine(ScheringPloughLtd) ClarytynAllergySyrup:oralsolution,1mg/mlloratidine(ScheringPloughLtd)
DrugType
Antihistamine.
Classification
Indications
For the symptomatic relief of allergic rhinitis (hay fever), including ocular symptoms and allergic skin conditions such as urticaria. See Clinical Management Guideline on Conjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytoloratidineoranycomponentofthepreparation.
Cautions
Second generation antihistamines are less lipophilic and do not penetrate the bloodbrain barrier to any significant extent. They are therefore less likely to cause centrally mediated effects e.g. drowsiness. However, approx. 6% of patients experience such effects and therefore patients need to be warned that loratadine may affect driving and other skilled tasks. Usewithcautioninpatientswithrenalorhepaticimpairment.
92
Pregnancy risk category B: In animal studies, loratadine was not teratogenic in doses many times in excess of the maximum recommended human dose. However, there are no adequate and wellcontrolled studies in pregnant women and because animal studies are not always predictive of human response, loratadine should be used in pregnancy only if clearly needed. Loratadine has been reported to be excreted in human breast milk and thereforeuseofloratadineinnursingmothersisnotrecommended.
Interactions
Avoidexcessivealcoholconsumption.
OcularSideEffects
Dryeyes Punctatekeratitis
Ocularsideeffectsarerare.
GeneralSideEffects
Drowsiness Headache Nervousness Fatigue
General side effects are rare. Loratadine is associated with a much lower incidence of sedationthancetirizineoracrivastine.
Dose
Adults&children(12yearsandover):One10mgtabletoncedaily. Children:212years<30Kgbodyweight5ml(5mg)oncedaily>30Kg10mloncedaily.
Storage
Storebelow25C.
93
Loteprednol Etabonate

LegalClassification
Lotemax:eyedrops,0.5%loteprednoletabonate(BauschandLomb)
Drugtype
Antiinflammatory.
Classification
Corticosteroid.
Indications/Use
Loteprednolisindicatedinthetreatmentofinflammationfollowingocularsurgery.Itisused offlicence for the treatment of inflammation of the conjunctiva, cornea or anterior segment.SeeClinicalManagementGuidelinesonPterygium,PingueculaandEpiscleritis.
Contraindications
Hypersensitivity to loteprednol or any component of the preparation. Loteprednol is contraindicatedinviraldiseasesofthe corneaandconjunctiva,fungal diseasesoftheeyeor otherinfectiousdiseaseswhereitmaymaskinfectionorenhanceanexistinginfection.
Cautions
Loteprednol, as with other corticosteroids, can cause ocular hypertension and should be used with caution in patients with glaucoma (see Clinical Management Guideline on Steroid Glaucoma). Prolonged use of corticosteroids may suppress host immune responses and increase the possibilityofsecondaryocularinfection. In diseases causing thinning of the cornea or sclera, corticosteroids have been associated withperforations. Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. Safety of loteprednol during pregnancy has not been established. Therefore, the use of loteprednol during pregnancy requires that the benefits be weighed
against the potential risks to the foetus. It is not known if loteprednol is excreted in human breastmilk.Cautionshouldbeexercisedwhenprescribingtobreastfeedingwomen.
94
Interactions
Concurrent administration of cycloplegics may increase the risk of raised intraocular pressure. In the case of concomitant use of another topical eye preparation, allow 510 minutesbetweenapplicationsofeachpreparation.
OcularSideEffects
Raisedintraocularpressure Posteriorsubcapsularcataractformation Secondaryocularinfection Perforationoftheglobe
The likelihood of ocular hypertension is reduced compared to other corticosteroids e.g. prednisolone. Ocular signs and symptoms similar to the underlying ocular disease being treated were reported with loteprednol in clinical trials e.g. ocular discomfort, epiphora, foreignbodysensation,hyperaemiaanditching.
GeneralSideeffects
Headache Tastedisturbance Dizziness Paresthesia
Headacheisacommonsideeffect,othersideeffectsarerare.
Dose
Adults: 12 drops should be instilled 4 times daily. Duration of therapy should not exceed 2 weeks.Notlicensedforuseinchildren.
Storage
Storebelow25C.
95
Minocycline

LegalClassification
Minocycline:capsules,50mgminocyclinehydrochloride(Nonproprietary) Minocycline:capsules,100mgminocyclinehydrochloride(Nonproprietary) Aknemin:tablets,50mgminocyclinehydrochloride(Almirall) Aknemin:tablets,100mgminocyclinehydrochloride(Almirall) ModifiedRelease AcnaminoMR:modifiedreleasecapsules,100mgminocyclinehydrochloride(Meda) MinocinMR:modifiedreleasecapsules,100mgminocyclinehydrochloride(Lederle) SebominMR:modifiedreleasecapsules,100mgminocyclinehydrochloride(Actavis)
DrugType
Antiinfective.
Classification
Antibacterial.
Indications
Minocycline has been found to be clinically effective in the treatment of a variety of infections caused by susceptible strains of Grampositive and Gramnegative bacteria and certainothermicroorganisms.Ithasaspectrumofactivitysimilartoothertetracyclinesbut more active against Staphylococcus aureus (see Clinical Management Guidelines on BlepharitisandOcularRosacea).
Contraindications
Hypersensitivity to minocycline or component of the preparation. Hypersensitivity to any other members of the tetracycline family. Minocycline is contraindicated in children less than12yearsofageandinpregnantornursingwomen.
Cautions
Use with caution in patients with hepatic impairment. May cause photosensitivity and patients should use skin protection, avoid prolonged exposure to sunlight and advised not use tanning equipment. A few cases of pregnancy have been attributed to the use of tetracycline antibiotics with oral contraceptives. Patients taking contraceptives containing
oestrogenshouldbewarnedthatthereisapossibilityofcontraceptivefailureandadvisedto use alternative forms of contraception during treatment. Use with caution in patients with SLEormyastheniagravisastetracyclinesmayexacerbatetheseconditions.
96
Pregnancy risk category D: contraindicated in pregnancy. Animal studies have shown that tetracyclines cross the placenta and can cause toxicity to the foetus. Yellowbrown discolouration of the teeth and enamel hypoplasia can occur when drugs of the tetracycline family are administered after the first trimester of pregnancy. Tetracyclines are excreted intobreastmilkandthereforecontraindicatedinnursingmothers.
Interactions
Antacids and preparations containing aluminium, calcium, magnesium, zinc, bismuth or iron may decrease the absorption of minocycline. Tetracyclines decrease plasma prothrombin activity and a dose reduction in patients taking anticoagulants may be necessary. Tetracyclinesmayreducetheeffectoforalcontraceptives(seecautions).
OcularSideEffects
GeneralSideEffects
Gastrointestinaldisturbancese.g.nausea,vomitinganddiarrhoea Discolourationofteethandenamelhypoplasia(youngchildren) Abnormalbonegrowth(youngchildren) Headache Photosensitivity Dizzinessandvertigo Benignintracranialhypertension
Gastrointestinal disturbances are commonly reported. Dizziness and vertigo are more common in women. The presence of headache and visual disturbance may indicate benign intracranialhypertension(discontinuetherapy).
Dose
Forblepharitisandocularrosacea:treatmentmayneedtobecontinuedforseveralweeksor months.
Adults:1x50mgtabletdaily(for2weeks)followedby100mgdailyfor3months. Contraindicatedinchildren.
97
Storage
Storebelow25C.
98
Nedocromil Sodium

LegalClassification
Rapitil:eyedrops,2%nedocromilsodium(SanofiAventis)
Drugtype
Antiinflammatory.
Classification
Mastcellstabilizer.
Indications
For the prevention, relief and treatment of allergic conjunctivitis, including seasonal allergic conjunctivitis, allergic conjunctivitis and vernal keratoconjunctivitis. Treatment of allergic conjunctivitis. See Clinical Management Guidelines on Atopic keratoconjunctivitis, Vernal keratoconjunctivitis, Conjunctivitis (Acute allergic), Conjunctivitis seasonal and perennial allergicandContactlensassociatedpapillaryconjunctivitis.
Contraindications
Hypersensitivitytonedocromiloranyconstituentofthepreparation.
Cautions
Pregnancy risk category B. Animal studies have failed to reveal a hazard with nedocromil sodium. However, as with all medications caution should be exercised during pregnancy (particularlyduringthe1sttrimester). On the basis of its physicochemical properties it is considered that only negligible amounts of nedocromil sodium may pass into human breast milk and there is no information to suggestthattheuseofnedocromilhasanyundesirableeffectsuponthebaby.
99
Interactions
OcularSideEffects
Transientstinging Transientburning
Transient stinging and burning following instillation is the most common side effects (10 30%).
GeneralSideEffects
Headaches Distinctivetaste
Headache is the most commonly reported side effect (approximately 40% of patients). Distinctivetastesometimesreported.
Dose
Seasonal and perennial conjunctivitis: adults & children (6 years and over), apply 1 drop twice daily, increased if necessary to four times daily. Full effect may take several days to occur.Maximumof12weekstreatmentforseasonalallergicconjunctivitis. Vernalkeratoconjunctivitis:adults&children(6yearsandover),applyfourtimesdaily.
Storage
Storebelow25C,awayfromdirectsunlight.
100
Ofloxacin

LegalClassification
Exocin:eyedrops,0.3%ofloxacin(Allergan)
Drugtype
Antiinfective.
Classification
Antibacterial.
Indications/Use
Ofloxacin is indicated for topical treatment of external ocular infections in adults and children caused by ofloxacinsensitive organisms (see Clinical Management Guideline for Nasolacrimalductobstruction).
Contraindications
Hypersensitivitytoofloxacinoranycomponentofthepreparation.
Cautions
Usewithcautioninpatientsexhibitingsensitivitytootherquinoloneantibiotics. Aswithotherantibioticsprolongedusemayleadtothedevelopmentofbacterialresistance. Risk of corneal perforation when used to treat patients with corneal epithelial defects and ulcers. Contains benzalkonium chloride as a preservative, which may accumulate in soft contact lenses and cause irritation. Manufacturer recommends that contact lenses should be removedbeforeinstillationandreinserted15minutesafteradministration.
Pregnancy risk category C. There are no adequate and well controlled studies in pregnant women. Systemic quinolones have caused arthropathy in animal studies. Therefore, the use ofofloxacininpregnancyrequiresthatthebenefitsbeweighedagainstthepotentialrisksto the foetus. Following systemic administration, ofloxacin has been detected in the milk of nursing mothers. The use of ofloxacin, while nursing, requires that the benefits be weighed againstthepotentialriskstothenursinginfant.
101
Interactions
OcularSideEffects
Transientburning Transientstinging Transienthyperaemia
Transient ocular irritation (burning, stinging, redness, itching or photophobia) on instillation hasbeencommonlyreported. Cornealprecipitateshavebeenreportedduringtreatmentwithtopicalophthalmicofloxacin. However,acausalrelationshiphasnotbeenestablished.
GeneralSideeffects
Nausea Headache Dizziness Numbness
Veryrarelyheadache,dizziness,numbnessandnauseahavebeenreportedinclinicaltrials. StevensJohnson syndrome has been reported in patients receiving topical ophthalmic ofloxacin,however,acausalrelationshiphasnotbeenestablished.
Dose
For adults & children (all ages): 12 drops to be instilled into the eye every 24 hours for the first2daysandthen4timesdaily.Treatmentshouldnotexceed10days.
Storage
Storebelow25C.
102
Olopatadine

LegalClassification
POM: For use and supply by additional supply optometrists. May be use and prescribed by independentprescribingoptometrists.
Opatanol:eyedrops,0.1%olopatadine(ashydrochloride)(Alcon)
DrugType
Antiinflammatory.
Classification
Antihistamine.
Indications
Treatment of ocular signs and symptoms of seasonal allergic conjunctivitis. See Clinical ManagementGuidelineonConjunctivitis(SeasonalandPerennial).
Contraindications
Hypersensitivitytoolopatadineortoanycomponentofthepreparation.
Cautions
Preparationcontainsbenzalkoniumchlorideasapreservative,whichmayaccumulateinsoft lenses and cause irritation. Manufacturer recommends that an interval of 1015 mins from instillation before contact lenses can be reinserted. The preparation should not be instilled whilewearingcontactlenses.
Pregnancy risk category C. Safety in pregnancy has not been established. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy. However, caution should be exercised when prescribing to pregnant women. Olopatadine has been detected in the milk of nursing rats following oral administration. It is not known whether topical administration to humans could result in sufficient systemic absorption to produce detectable quantities in human breast milk. Olopatadine is therefore not recommended for breastfeedingmothers.
103
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allowatleast10minutesbetweeneachapplication.
OcularSideEffects
Transientirritation Eyepain Dryeye Keratitis Itching Photophobia Conjunctivalhyperaemia
In clinical trials side effects were experienced by 4.5% of patients. The most frequently reported treatmentrelated undesirable effect in clinical trials was eye pain with an incidenceof0.7%.Otheradversereactionsarerare(0.1%).
GeneralSideEffects
Headaches Nasaldryness Asthenia Dizziness Rhinitis Hypersensitivity
Headacheandnasaldrynesswerethemostcommonlyreportedgeneralsideeffects(110%). Othergeneralsideeffectsareuncommon.
Dose
Adults & children (3 years and over), apply 1 drop twice daily. Maximum duration of treatment4months.
Storage
Storebelow25C.
104
Oxybuprocaine Hydrochloride (Benoxinate)

LegalClassification
SingleUse(Preservativefree): MinimsOxybuprocaine:eyedrops,0.4%oxybuprocainehydrochloride(Bausch&Lomb)
DrugType
Localanaesthetic.
Classification
Estertypelocalanaesthetic.
Indications
Ocular anaesthesia for shortterm procedures e.g. Goldmann applanation tonometry, gonioscopy,minorsurgery.
Contraindications
Hypersensitivitytooxybuprocaineorotherestertypeanaesthetics. In view of the immaturity of the enzyme system which metabolises the ester type local anaestheticsinprematurebabies,oxybuprocaineshouldbeavoidedinthesepatients.
Cautions
The eye should be protected from foreign bodies and rubbing during the period of anaesthesia (up to 30 minutes). Ideally the patient should not leave the practice until cornealsensationhasreturned.
Pregnancy risk category C. No well controlled clinical trials have been conducted in pregnancy and lactation. Oxybuprocaine should not be used unless considered essential by theclinician.
Interactions
Nonereported.
105
OcularSideEffects
Transientstinging Transientblurring Punctatekeratitis
Hypersensitivity reactions may rarely occur, characterised by allergic conjunctivitis and peri orbitaloedema.
GeneralSideEffects
Dose
Adults & children (1 month and over). One drop is sufficient to anaesthetise the surface of the eye to allow tonometry after one minute. Three drops at 90 second intervals provides sufficientanaesthesiaforaforeignbodytoberemovedfromthecornealepithelium.
Storage
106
Oxytetracycline

LegalClassification
Oxytetracycline:tablets,250mgoxytetracyclinedihydrate(Nonproprietary)
DrugType
Antiinfective.
Classification
Antibacterial.
Indications
Oxytetracycline has been found to be clinically effective in the treatment of a variety of infections caused by susceptible strains of Grampositive and Gramnegative bacteria and certain other microorganisms (see Clinical Management Guidelines on Blepharitis and OcularRosacea).
Contraindications
Hypersensitivitytooxytetracyclineorcomponentofthepreparation.Hypersensitivity toany other members of the tetracycline family. Oxytetracycline is contraindicated in children less than12yearsofageandinpregnantornursingwomen.
Cautions
Use with caution in patients with renal or hepatic impairment. May cause photosensitivity and patients should use skin protection, avoid prolonged exposure to sunlight and advised not use tanning equipment. A few cases of pregnancy have been attributed to the use of tetracycline antibiotics with oral contraceptives. Patients taking contraceptives containing oestrogenshouldbewarnedthatthereisapossibilityofcontraceptivefailureandadvisedto use alternative forms of contraception during treatment. Use with caution in patients with SLEormyastheniagravisastetracyclinesmayexacerbatetheseconditions.
Pregnancy risk category D: contraindicated in pregnancy. Animal studies have shown that tetracyclines cross the placenta and can cause toxicity to the foetus. Yellowbrown discolouration of the teeth and enamel hypoplasia can occur when drugs of the tetracycline
family are administered after the first trimester of pregnancy. Tetracyclines are excreted intobreastmilkandthereforecontraindicatedinnursingmothers.
107
Interactions
Antacids and preparations containing aluminium, calcium, magnesium, zinc, bismuth or iron maydecreasetheabsorptionofoxytetracycline.Tetracyclinesdecreaseplasmaprothrombin activity and a dose reduction in patients taking anticoagulants may be necessary. Tetracyclinesmayreducetheeffectoforalcontraceptives(seecautions).
OcularSideEffects
GeneralSideEffects
Gastrointestinaldisturbancese.g.nausea,vomitinganddiarrhoea Discolourationofteethandenamelhyoplasia(youngchildren) Abnormalbonegrowth(youngchildren) Headache Photosensitivity Benignintracranialhypertension
Gastrointestinal disturbances are commonly reported. The presence of headache and visual disturbancemayindicatebenignintracranialhypertension(discontinuetreatment).
Dose
Forblepharitisandocularrosacea:treatmentmayneedtobecontinuedforseveralweeksor months. Adults:2x250mgtabletstwicedaily. Contraindicatedinchildren.
Storage
Storebelow25C.
108
Paracetamol

LegalClassification
POM: ParacetamolTablets:500mgparacetamol(Nonproprietary) PanadolOA:tablets,1gparacetamol(GSK) Combinationproducts: Cocodamol:tablets,8mgcodeinephosphate,500mgparacetamol(Nonproprietary) Kapake:tablets,15mgdihydrocodeinetartrate,500mgparacetamol(Galen) Cocodamol:tablets,30mgcodeinephosphate,500mgparacetamol(Nonproprietary) PandGSL(P.Packsizeupto32.GSL.Packsize16orless): Paracetamol:tablets,500mgparacetamol(Nonproprietary) AnadinParacetamolTablets:500mgparacetamol(WyethConsumerHealthcare) Hedex:tablets,500mgparacetamol(GSKConsumerHealthcare) HedexExtra:tablets,500mgparacetamol(withcaffeine)(GSKConsumerHealthcare) PanadolAdvance:tablets,500mgparacetamol(GSKConsumerHealthcare) PanadolExtra:tablets500mgparacetamol(withcaffeine)(GSKConsumerHealthcare) PanadolSoluble:effervescenttablets,500mgparacetamol(GSKConsumerHealthcare) Preparationsforchildren: CalpolSixPlusSuspension:250mgper5mlparacetamol(McNeilProductsLtd) CalpolSugarfreeInfantSuspension:120mgper5mlparacetamol(McNeilProductsLtd) Disprol Paracetamol Suspension: 120mg per 5ml paracetamol, sugarfree (Reckitt Benckister Healthcare) Medisedforchildren:120mgper5mlparacetamol(SSLInternationalPLC) Combinationproducts: AnadinExtra:tablets200mgparacetamol,300mgaspirin(WyethConsumerHealthcare)) DisprinExtra:tablets,200mgparacetamol,300mgaspirin(ReckittBenckisterHealthcare) Panadol Ultra: tablets, 500mg paracetamol, 12.8mg codeine phosphate (GSK Consumer Health) Solphadeine Plus: capsules, 500mg paracetamol, 8mg codeine phosphate (GSK Consumer Health)
109
DrugType
Classification
Nonopioidanalgesicsandantipyrexic.
Indications
Mildtomoderatepainfromavarietyofcausesandthetreatmentofpyrexia.
Contraindications
Hypersensitivitytoparacetamoloranycomponentofthepreparation.
Cautions
Paracetamol is a very safe drug at normal therapeutic dosages, however it is hepatotoxic in overdose. It is therefore extremely important to ensure that patients do not exceed the recommended dose and do not use more than one paracetamolcontaining product at a time. Care is advised in the administration of paracetamol to patients with severe renal or severe hepaticimpairment.
Pregnancy risk category B. There is clinical and epidemiological evidence of safety of paracetamol in pregnancy and it is the preferred analgesic in pregnant women, if required. Paracetamol is excreted in breast milk but not in clinically significant amounts. Available publisheddatadonotcontraindicatebreastfeeding.
Interactions
Nosignificantinteractionsrelatingtoshorttermuse.
OcularSideEffects
None
GeneralSideEffects
Hypersensitivityreactions Hepatotoxicity
Sideeffects are rare, but rashes, blood disorders (including thrombocytopenia, leucopenia, neutropenia)havebeenreported.Hepatotoxicitycanoccurinoverdoseandisoftenfatal.
110
Dose
Adults&children(12yearsandover):0.51gevery46hours.Maximumdailydose4g. Children: 312 months 60120mg, 15 years 120250mg, 612 years 250500mg, all 46 hourlytoamaximumof4dosesin24hours.
Storage
Storebelow25C.
111
Paraffin, Yellow, Soft

LegalClassification
SimpleEyeOintment:eyeointment,10%yellowsoftparaffin10%woolfat(NonProprietary)
DrugType
Classification
Ocularlubricant.
Indications
Lubrication and protection of the eye in conditions such as exposure keratitis, decreased corneal sensitivity, recurrent corneal erosions and keratoconjunctivitis sicca. See Clinical Management Guidelines on Tear Deficiency, Recurrent Corneal Erosion, Ectropion, Entropion,TrichiasisandFacialPalsy.
Contraindications
Hypersensitivitytoyellowsoftparaffinoranycomponentofthepreparation.
Cautions
Contactlensesshouldberemovedpriortoinstillationandshouldnotbeinsertedforatleast 30minutes.
Pregnancy risk category C. The constituents of the available preparation have been used as pharmaceutical agents for many years with no untoward effects. No special precautions are thereforenecessaryfortheiruseinpregnancyorlactation.
Interactions
112
OcularSideEffects
Transient blurring lasting 115 minutes occurs following instillation. Hypersensitivity reactionscanrarelyoccur.
GeneralSideEffects
None
Dose
Adults & children (1 month and over). For recurrent erosion apply a small amount into the affectedeyebeforebedtime.
Storage
Storebelow25C.
113
Phenylephrine Hydrochloride

LegalClassification
Phenylephrine Hydrochloride: eyedrops, 10% phenylephrine hydrochloride (Non proprietary) SingleUse(Preservativefree): MinimsPhenylephrine:eyedrops,2.5%phenylephrinehydrochloride(Bausch&Lomb) MinimsPhenylephrine:eyedrops,10%phenylephrinehydrochloride(Bausch&Lomb)
DrugType
MydriaticandCycloplegic.
Classification
Sympathomimetic.
Indications
Phenylephrine is a directly acting sympathomimetic agent used topically as a mydriatic for diagnosticortherapeuticprocedures.
Contraindications
Hypersensitivity to phenylephrine or any other of component of the preparation. Contraindicated in patients with cardiac disease, hypertension, aneurysms, asthma, thyrotoxicosis, longstanding insulindependent diabetes mellitus and tachycardia; patients on monoamine oxidase inhibitors (MAOI), tricyclic antidepressants and antihypertensive agents (including betablockers); patients with closed angle glaucoma and patients with a narrowangle(pronetoglaucomaprecipitatedbymydriatics).
Cautions
Toreducetheriskofprecipitatinganattackofnarrowangleglaucoma,evaluatetheanterior chamber angle before use. Corneal clouding may occur if phenylephrine 10% is instilled when the corneal epithelium has been denuded or damaged. Avoid 10% phenylephrine in childrenandtheelderly.
114
Pregnancy risk category C. There is no evidence as to the drug's safety in human pregnancy and should only be used if considered essential by the clinician. Phenylephrine should only be used in pregnancy if the potential benefit outweighs the risk to the developing foetus. Safety in lactation has not been established and therefore should not be used in nursing mothers.
Interactions
Antihypertensive Agents: Topical phenylephrine should not be used as it may reverse the action of many antihypertensive agents with possible fatal consequences. Phenylephrine also interacts with monoamine oxidase Inhibitors, tricyclic antidepressants, cardiac glycosidesorquinidine(increasedriskofcardiovascularevents). In the case of concomitant use of another topical eye preparation, allow 510 minutes betweenapplicationsofeachpreparation.
OcularSideEffects
Transientstinging Transientblurring Photophobia Lidretraction Conjunctivalallergicreaction Raisedintraocularpressure Punctatekeratitis
Transient irritation on instillation, temporarily blurred vision and photophobia are the most commonadversereactions.
GeneralSideEffects
Palpitations Tachycardia Cardiacarrhythmias Hypertension Headaches
Serious cardiovascular reactions including coronary artery spasm, ventricular arrhythmias and myocardial infarctions have occurred following topical use of10% phenylephrine. These sometimes fatal reactions have usually occurred in patients with preexisting cardiovascular disease.
115
Dose
Adults&children(2.5%strength,3monthsandover):apply1droptoeacheye.Ifnecessary, repeatdoseonceonly,atleastonehourafterthefirstdrop. 10% phenylephrine is contraindicated in children and the elderly (>65 years) because of the increasedriskofsystemictoxicity.
Storage
116
Pilocarpine

LegalClassification
Pilocarpine hydrochloride: eyedrops, 1%, 2%, 3% or 4% pilocarpine hydrochloride (non proprietary) SingleUse(Preservativefree): MinimsPilocarpineNitrate:eyedrops,2%pilocarpinenitrate(Bausch&Lomb) LongActing: Pilogel:ophthalmicgel,4%pilocarpinehydrochloride(Alcon)
DrugType
Miotic.
Classification
Parasympathomimetic.
Indications
To overcome the action of the weaker sympathomimetic mydriatics. Emergency treatment of acute closed angle glaucoma. See Clinical Management Guideline on angle closure glaucoma.
Contraindications
Hypersensitivity to pilocarpine or any component of the preparation. Contraindicated in conditions where pupil constriction is undesirable e.g. anterior uveitis and some forms of secondaryglaucoma.
Cautions
Systemic reactions rarely occur at normal doses. However, in the emergency treatment of acute closedangle glaucoma the possibility of systemic reactions must be considered because of the higher doses given. Caution is particularly advised in patients with acute heart failure, bronchial asthma, peptic ulceration, hypertension, urinary tract obstruction and Parkinson's disease. Systemic absorption may be reduced by compressing the lacrimal sacatthemedialcanthusduring,andfor23minsafterinstillationofthedrops.
Retinaldetachmentshavebeencausedinsusceptibleindividualsandthosewithpreexisting retinaldisease,therefore, fundusexaminationisadvisedinallpatientsprior to theinitiation oftherapy Contact lenses should not be worn during treatment. Multidose preparations contain benzalkonium chloride as a preservative, which may be accumulate in soft lenses and cause irritation.
117
Pregnancy risk category C. There are no adequate and well controlled studies in pregnant women. Therefore, the use of pilocarpine in pregnancy requires that the benefits be weighed against the potential risks to the foetus. It is not known whether pilocarpine is excretedinbreastmilk.Itshouldthereforebeusedwithcautioninnursingmothers.
Interactions
There are no relevant interactions. In the case of concomitant use of another topical eye preparation,allow510minutesbetweenapplicationsofeachpreparation.
OcularSideEffects
Transientburning Transientstinging Tearing Inducedmyopia Ciliaryspasm Conjunctivalvascularcongestion Follicularconjunctivitis Reducedacuityinlowillumination Retinaldetachment
Induced myopia and ciliary spasm are common in younger patients. This should be borne in mindwhenconsideringtheuseofpilocarpineforthereversalofmydriasis.
GeneralSideEffects
Headaches Hypertension Tachycardia Bronchialspasm Salivation Sweating Nausea
Systemicsideeffectsarerareatnormaldosesbutneedtobeconsideredwhenhigherdoses aregiven.
118
Dose
Adults & children (2 years and over). To induce miosis, 1 or 2 drops (2% or 4%) should be used. In cases of emergency treatment of acute narrowangle glaucoma, 1 drop (4%) should beusedeveryfiveminutesuntilmiosisisachieved. Children:1month2years.Use0.5%or1%.
Storage
119
Polymyxin B Sulphate

LegalClassification
Polyfax Ophthalmic Ointment: polymyxin B sulphate 10,000 international units (IU), bacitracinzinc500IU/g(TevaUK) Polytrim:(NolongercommerciallyavailableintheUK)
Drugtype
Antiinfective.
Classification
Antibacterial.
Indications
Polymyxin B is a bacteriostatic antibiotic indicated for the treatment of bacterial infections of the eye and its adnexa, e.g. conjunctivitis, keratitis, corneal ulceration and ulcerative blepharitis.Alsocanbeappliedprophylacticallyfollowingforeignbodyremoval. SeeClinicalManagementGuidelinesonBlepharitisandForeignbody(subtarsal)
Contraindications
HypersensitivitytopolymyxinBoranycomponentsofthepreparation.
Cautions
Following significant systemic absorption polymyxin B sulphate and bacitracin zinc have nephrotoxic potential and polymixin B sulphate has neurotoxic potential. However, this is extremelyunlikelyfollowingtopicaladministration. Contact lenses should not we worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnacy risk category C. Animal reproduction studies have not been conducted with polymyxin B sulphate or bacitracin. It is also not known whether bacitracin or polymyxin B can cause foetal harm when administered to a pregnant woman. Therefore, the use of polymyxin/bacitracin in pregnancy requires that the benefits be weighed against the
potential risks to the foetus. It is not known whether bacitracin or polymyxin B is excreted inhumanmilkanditisnotrecommendedthattheyareusedinnursingmothers.
120
Interactions
Following significant systemic absorption, polymyxin B sulphate can intensify and prolong the respiratory depressant effects of neuromuscular blocking agents (skeletal muscle relaxants).However,thisisextremelyunlikelyfollowingtopicaladministration. In the case of concomitant use of another topical eye preparation, allow 510 minutes betweenapplicationofeachpreparation.
OcularSideEffects
Transientirritation Itching. Conjunctivalerythema Conjunctivaloedema
Transient irritation on instillation may occur. Hypersensitivity reactions, causing itching, conjunctival erythema and odema occur rarely. Contact dermatitis has also been described affectingtheeyelidsandperiorbitalskin.
GeneralSideEffects
Nonereported.
Dose
Adults & children (1 month and over). A thin film of ointment should be applied to the affected part or inside of the lower eyelid two or more times a day depending on the severityofthecondition. Treatment should be continued until at least two days after the eye has apparently recovered.
Storage
Storebelow25oC.
121
Povidone

LegalClassification
AvizorComfortDrops:eyedrops,1%Povidone(Avizor) SingleUse(Preservativefree): Oculotect:eyedrops,5%povidone(Novartis)
DrugType
Classification
Artificialtears.
Indications
Treatment of dry eye or an unstable tear film. See Clinical Management Guidelines on Tear Deficiency.
Contraindications
Hypersensitivitytopovidoneoranycomponentofthepreparation.
Cautions
None.
PregnancyriskcategoryC.Therearenoadequateandwellcontrolledstudiesofpovidonein pregnant woman or lactation. Povidone should be used with caution and only if the expectedbenefittothemotherisgreaterthananypossiblerisktothefoetusorbaby.
Interactions
122
OcularSideEffects
GeneralSideEffects
None
Dose
Adults&children(1monthandover).Apply1or2dropsfourtimesperdayorasrequired.
Storage
123
Prednisolone

LegalClassification
Predsol:eyedrops,0.5%prednisolonesodiumphosphate(UCBPharma) PredForte:eyedrops,1%prednisoloneacetate(Allergan) Singleuse Minims Prednisolone Sodium Phosphate: eye drops, single dose units containing 0.5% prednisolonesodiumphosphate(BauschandLomb) Combination Predsol N: eye drops, 0.5% prednisolone sodium phosphate with 0.5% neomycin sulphate (Celltech)
Drugtype
Antiinflammatory.
Classification
Corticosteroid.
Indications/Use
Prednisolone is indicated in the shortterm treatment of corticosteroidresponsive inflammation of the conjunctiva, cornea and anterior segment. See Clinical Management GuidelinesonKeratitis(Marginal)andAnteriorUveitis.
Contraindications
Hypersensitivity to prednisolone or any component of the preparation. Prednisolone is contraindicatedinviraldiseasesofthe corneaandconjunctiva,fungal diseasesoftheeyeor otherinfectiousdiseaseswhereitmaymaskinfectionorenhanceanexistinginfection.
Cautions
Prednisolone, as with other corticosteroids, can cause ocular hypertension and should be used with caution in patients with glaucoma (see Clinical Management Guideline on Steroid Glaucoma). Prolonged use of corticosteroids may suppress host immune responses and increase the possibilityofsecondaryocularinfection.
In diseases causing thinning of the cornea or sclera, corticosteroids have been associated withperforations. Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
124
Pregnancy risk category C. Safety of prednisolone during pregnancy has not been established. Therefore, the use of prednisolone during pregnancy requires that the benefits be weighed against the potential risks to the foetus. It is not known if prednisolone is excreted in human breast milk. Caution should be exercised when prescribing to breast feedingwomen.
Interactions
OcularSideEffects
Blurredvision Oculardischarge Ocularpain Foreignbodysensation Raisedintraocularpressure Posteriorsubcapsularcataractformation Secondaryocularinfection Perforationoftheglobe
In clinical trials the most frequently reported side effects were blurred vision (2.6%) and ocular discharge (2.2%). Ocular signs and symptoms similar to the underlying ocular disease being treated were reported in clinical trials e.g. ocular discomfort, epiphora, foreign body sensation,hyperaemiaanditching.
GeneralSideeffects
Headache Hypotension Rhinitis Pharyngitis Tastedisturbance
General side effects are rare. Local side effects of steroid therapy e.g. skin atrophy, striae andtelangiectasiamayaffectfacialskin.
125
Dose
For adults & children (2 years and over): 12 drops should be instilled every 12 hours until inflammationiscontrolledandthenreducefrequency.
Storage
Storebelow25C.
126
Propamidine Isetionate/ Dibromopropamidine Isetionate

LegalClassification
BroleneEyeDrops:0.1%propamidineisetionate(SanofiAventis) GoldenEyeDrops:0.1%propamidineisetionate(Typharm) BroleneEyeOintment:0.15%dibromopropamidineisetionate(SanofiAventis) GoldenEyeOintment:0.15%dibromopropamidineisetionate(Typharm)
Drugtype
Antiinfective.
Classification
Antibacterial.
Indications
Propamidine isetionate is an aromatic diamidine disinfectant, which is active against Gram +ve, but less active against Gramve bacteria. It may be used topically for the treatment of minor eye infections e.g. conjunctivitis and blepharitis. It also has antifungal and anti amoebicproperties. SeeClinicalManagementGuidelinesonConjunctivitis(Bacterial)andBlepharitis.
Contraindications
Hypersensitivity to propamidine/ dibromopropamidine or any component of the preparation.
Cautions
Contact lenses should not we worn during treatment. Eyedrop formulations contain benzalkonium chloride as a preservative, which may accumulate in soft lenses and cause irritation.
Pregnancy risk category C. There are no adequate and well controlled studies in pregnant women. Therefore, the use of propamidine (or dibromopropamidine) in pregnancy requires that the benefits be weighed against the potential risks to the foetus. It is not known
whether propamidine (or dibromopropamidine) is excreted in breast milk. It should thereforebeusedwithcautioninnursingmothers.
127
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allowatleast510minutesbetweenapplicationsofeachpreparation.
OcularSideEffects
Transientstinging Transientblurring.
Transient stinging and blurring (particularly with the ointment formulation) may occur on instillation.Hypersensitivityreactionsmayrarelyoccur.
GeneralSideEffects
Nonereported.
Dose
For adults & children (1 month and over): eyedrops, apply 1 or 2 drops up to four times daily. Ointment,applytopicallyonceortwicedaily.
Storage
Storebelow25C.
128
Propylethylene Glycol 400

LegalClassification
Systane Lubricating Eye Drops: 0.4% polyethylene glycol 400 and 0.3% propylene glycol demulcentswithHPGuar(hydroxypropylguar)asagellingagent(Alcon) SingleUse(Preservativefree): Systane Lubricating Eye Drops: 0.4% polyethylene glycol 400 and 0.3% propylene glycol demulcentswithHPGuar(hydroxypropylguar)asagellingagent(Alcon)
DrugType
Classification
Artificialtears.
Indications
Contraindications
Hypersensitivitytopolyethyleneglycoloranycomponentofthepreparation.
Cautions
Multidose preparation contains preservatives which may accumulate in soft contact lenses and cause irritation. Consider single use (unpreserved) preparations in soft lens wearers. Consultpreservativetablesforcontactlenscompatibility.
Pregnancy risk category C. There are no adequate and wellcontrolled studies of in pregnant woman or lactation. This product should therefore be used with caution, and only if the expectedbenefittothemotherisgreaterthananypossiblerisktothefoetusorbaby.
129
Interactions
OcularSideEffects
GeneralSideEffects
None
Dose
Adults & children (from 1 month). Apply 1or 2 drops three to four times per day or as required.
Storage
Storebelow25C.
130
Proxymetacaine Hydrochloride

LegalClassification
SingleUse(Preservativefree): MinimsProximetacaine:eyedrops,0.5%proxymetacainehydrochloride(Bausch&Lomb) Minims Proximetacaine and Fluorescein: eyedrops, 0.5% proxymetacaine hydrochloride, 0.25%fluorescein(Bausch&Lomb)
DrugType
Localanaesthetic.
Classification
Indications
Ocular anaesthesia for shortterm procedures e.g. Goldmann applanation tonometry, gonioscopy,minorsurgery.
Contraindications
Hypersensitivitytoproxymetacaineorotherestertypeanaesthetics. In view of the immaturity of the enzyme system which metabolises the ester type local anaestheticsinprematurebabies,proxymetacaineshouldbeavoidedinthesepatients.
Cautions
Proxymetacaine should be used cautiously and sparingly in patients with known allergies, cardiacdiseaseorhyperthyroidismbecauseoftheincreasedriskofsensitivityreactions. Theeyeshouldbeprotectedfromforeignbodiesandrubbingduringeperiodofanaesthesia (up to 30 minutes). Ideally the patient should not leave the practice until corneal sensation hasreturned.
Pregnancy risk factor C. No well controlled clinical trials have been conducted in pregnancy orlactation.Proxymetacaineshouldnotbeusedunlessconsideredessentialbytheclinician.
131
Interactions
Nonereported.
OcularSideEffects
Transientstinging Transientblurring Punctatekeratitis Conjunctivalhyperaemia
Pupillary dilatation or cycloplegic effects have rarely been observed with proxymetacaine. A severe, immediatetype apparently hyperallergic corneal reaction may rarely occur. This includes acute, intense and diffuse epithelial keratitis; a grey groundglass appearance and sloughingoflargeareasofnecroticepithelium.
GeneralSideEffects
Dose
Adults&children(1monthandover).1or2dropsissufficienttoanaesthetisethesurfaceof theeyetoallowtonometryorforeignbodytoberemovedfromthecornealepithelium.
Storage
Store at 2 8C. Protect from light. If necessary, the product may be stored at temperatures notexceeding25Cforupto1monthonly.
132
Polyvinyl Alcohol

LegalClassification
P LiquifilmTears:eyedrops,1.4%polyvinylalcohol(Allergan) SnoTears:eyedrops,1.4%polyvinylalcohol(Bausch&Lomb) Singleuse(Preservativefree): LiquifilmTears:eyedrops,1.4%polyvinylalcohol(Allergan) CE BlinkRefreshingEyeDrops:1.4%polyvinylalcohol(AMO) ClinitasUltra3:1.8%polyvinylalcohol,2.0%povidone(Altacor) PVA1.4%Tubilux:eyedrops,1.4%polyvinylalcohol(M&APharmachem) Singleuse(Preservativefree): BlinkRefreshingEyeDrops,1.4%polyvinylalcohol(AMO)
DrugType
Classification
Artificialtears.
Indications
Contraindications
Hypersensitivitytopolyvinylalcoholoranycomponentofthepreparation.
Cautions
Some multidose preparations contain preservatives (benzalkonium chloride or cetrimide) which may accumulate in soft contact lenses and cause irritation. Consider single use
(unpreserved) preparations in soft lens wearers. Consult preservative tables for contact lens compatibility.
133
Pregnancy risk category C. Although there are no adequate and wellcontrolled studies of polyvinyl alcohol in pregnancy or lactation, polyvinyl alcohol have been used as pharmaceutical agents for many years with no untoward effects. No special precautions are thereforenecessaryfortheuseofpolyvinylalcoholinpregnancyandlactation.
Interactions
OcularSideEffects
Transientblurring Transientstinging Eyeirritation Foreignbodysensation Itching Hyperaemia
GeneralSideEffects
None
Dose
Adults & children (1 month and over). Apply 1 or 2 drops three to four times per day or as required.If>6dropsperdayconsideranonpreservedtearsupplement.
Storage
Storebelow25C.Donotrefrigerate.
134
Rimexolone

LegalClassification
Vexol:eyedrops,1%rimexolone(Alcon)
Drugtype
Antiinflammatory.
Classification
Corticosteroid.
Indications/Use
Rimexolone is indicated in the treatment of inflammation following ocular surgery and the treatment of anterior uveitis and corticosteroidresponsive inflammation of the conjunctiva, corneaandanteriorsegment.SeeClinicalManagementGuidelinesonPterygium,Pinguecula andEpiscleritis.
Contraindications
Hypersensitivity to rimexolone or any component of the preparation. Rimexolone is contraindicatedinviraldiseasesofthe corneaandconjunctiva,fungal diseasesoftheeyeor otherinfectiousdiseaseswhereitmaymaskinfectionorenhanceanexistinginfection.
Cautions
Rimexolone, as with other corticosteroids, can cause ocular hypertension and should be used with caution in patients with glaucoma (see Clinical Management Guideline on Steroid Glaucoma). Prolonged use of corticosteroids may suppress host immune responses and increase the possibilityofsecondaryocularinfection. In diseases causing thinning of the cornea or sclera, corticosteroids have been associated withperforations. Contact lenses should not be worn during treatment. Contains benzalkonium chloride as a preservative,whichmayaccumulateinsoftlensesandcauseirritation.
135
Pregnancy risk category C. Safety of rimexolone during pregnancy has not been established. Therefore, the use of rimexolone during pregnancy requires that the benefits be weighed against the potential risks to the foetus. It is not known if rimexolone is excreted in human breastmilk.Cautionshouldbeexercisedwhenprescribingtobreastfeedingwomen.
Interactions
OcularSideEffects
Raisedintraocularpressure Posteriorsubcapsularcataractformation Secondaryocularinfection Perforationoftheglobe Blurredvision Oculardischarge
The likelihood of ocular hypertension is reduced compared to other corticosteroids e.g. prednisolone. Ocular signs and symptoms similar to the underlying ocular disease being treated were reported in clinical trials e.g. ocular discomfort, epiphora, foreign body sensation,hyperaemiaanditching.
GeneralSideeffects
Headache Rhinitis Tastedisturbance
Dose
Adults: 1 drop should be instilled 4 times daily. Duration of therapy should not exceed 4 weeks.Notlicensedforuseinchildren.
Storage
Storebelow25C.
136
Rose Bengal

LegalClassification
RoseBengalOphthalmicStrips:1.3mgRoseBengalperstrip(AlkornInc)
DrugType
Classification
Diagnosticstain.
Indications
As a diagnostic stain. Rose bengal solution stains degenerated conjunctival and corneal epithelialcells.Itisparticularlyusefulinthediagnosisofkeratoconjunctivitissicca.
Contraindications
Hypersensitivity to rose bengal or any component of the preparation. Rose bengal is able to penetratesoftcontactlensesandthereforeshouldnotbeusedwhensoftcontactlensesare worn.
Cautions
Causesseverestinginginpatientswithdryeyes.
Pregnancy risk category C. The use of rose bengal over the last 15 years has not shown any adverse effects. In the absence of any teratology studies, however, rose bengal is not recommended in pregnancy unless the therapeutic benefit exceeds the potential risk. It is not known whether rose bengal is secreted in breast milk. Therefore use with caution in nursingmothers.
Interactions
Noneknown.
137
OcularSideEffects
Transientblurring Stinging
Staining of the eyelids in the case of overspill tearing following application. Stinging more pronouncedinpatientswithdryeyes.
GeneralSideEffects
None
Dose
Adults&children(1monthandover).1or2dropsisusuallysufficientformostindications.
Storage
Storebelow25C.
138
Sodium Cromoglicate

LegalClassification
POM:Foruseandsupplybyadditionalsupplyoptometrists. P:Foruseandsupplybyalloptometrists.
POM Sodiumcromoglicate:eyedrops,2%sodiumcromoglicate(Nonproprietary) Vividrin:eyedrops,2%sodiumcromoglicate(NuCare) HayCromAqueousEyeDrops:2%sodiumcromoglicate(IVAX) OpticromAqueousEyeDrops:2%.sodiumcromoglicate(SanofiAventis) OvertheCounter(Pformulation) PollenaseAllergy:eyedrops,2%.sodiumcromoglicate(Peach) ClaritynAllergy:eyedrops,2%.sodiumcromoglicate(ScheringPlough) GalpharmAllergyEyeDrops:2%.sodiumcromoglicate(Galpharm) NumarkAllergyEyedrops:2%.sodiumcromoglicate(Numark) OpticromAllergy:eyedrops,2%.sodiumcromoglicate(SanofiAventis) OptrexAllergyEyes:eyedrops,2%.sodiumcromoglicate(CrookesHealthcare) Singleuse Catacrom:eyedrops,2%sodiumcromoglicate(MoorfieldsPharmaceuticals) InDecember2008,2%sodiumcromoglicateeyedropswerereclassifiedfromPtoGSLforthe relief and treatment of symptoms of hay fever (not to be used in children <6 years and not formorethan14dayswithoutconsultingadoctor,pharmacist(oroptometrist)).
Drugtype
Antiinflammatory.
Classification
Mastcellstabilizer.
Indications
POM: For the prophylaxis and symptomatic treatment of acute allergic conjunctivitis, chronicallergicconjunctivitisandvernalkeratoconjunctivitis. P:Forthereliefandtreatmentofseasonalandperennialallergicconjunctivitis.
See Clinical Management Guidelines on Atopic keratoconjunctivitis, Vernal keratoconjunctivitis, Conjunctivitis (Acute allergic), Conjunctivitis seasonal and perennial allergicandContactlensassociatedpapillaryconjunctivitis.
139
Contraindications
Hypersensitivitytosodiumcromoglicateoranycomponentofthepreparation.
Cautions
Contactlenswearshouldnotbewornduringtreatment.Preparationscontainbenzalkonium chlorideasapreservative,whichmayaccumulateinsoftlensesandcauseirritation.
Pregnancy risk category C. As with all medications, caution should be exercised especially during the first trimester of pregnancy. Cumulative experience with sodium cromoglicate suggeststhatithasnoadverseeffectsonfoetaldevelopment.However,itshouldbeusedin pregnancy only where there is a clear clinical need. It is not known whether sodium cromoglicate is excreted in human breast milk but on the basis of its physicochemical properties, this is considered unlikely. There is no information to suggest the use of sodium cromoglicatehasanyundesirableeffectsonthebaby.
Interactions
There are no reported interactions. In the case of concomitant use of another topical eye preparation,allow510minutesbetweeneachapplication.
OcularSideEffects
Transientburning Transientstinging Transientblurring
Transient stinging, burning, and blurring of vision may occur. Other symptoms of local irritationhavebeenreportedrarely.
GeneralSideEffects
Nonereported
Dose
Adults&children(1 monthandover): 1or2dropstobeadministeredintoeacheye4times daily.
Storage
Storebelow30C.Protectfromdirectsunlight.
140
Soya Lecithin

LegalClassification
EyeLogicSprayReliefforDryEyes:1.0%SoyaLecithin,0.025%VitaminApalmitate,0.002% VitaminE(tocopherol)(EyeLogic) OptrexActimistEyeSpray:(CrookesHealthcare)
DrugType
Artificialtears/Ocularlubricants
Classification
Liposomespray
Indications
Contraindications
Hypersensitivitytoanycomponentofthepreparation.
Cautions
Donotspraydirectlyintotheeyes
Pregnancy risk category C. There are no adequate and wellcontrolled studies of in pregnant woman or lactation. However, the components of the preparation are either naturally occurringorusedextensivelyinotherproductse.g.cosmeticswithnoreportedsideeffects.
Interactions
141
OcularSideEffects
Transientstingingifsprayeddirectlyintotheeyes.
GeneralSideEffects
None
Dose
Adults&children(1monthandover).Hold10cmawayfromtheclosedeyelidsandspray12 timesontotheclosedlidsthreetofourtimesperday.
Storage
Storebelow25C.
142
Tetracaine Hydrochloride (Amethocaine)

LegalClassification
SingleUse(Preservativefree): MinimsTetracaine:eyedrops,0.5%tetracainehydrochloride(Bausch&Lomb) MinimsTetracaine:eyedrops,1%tetracainehydrochloride(Bausch&Lomb)
DrugType
Localanaesthetic.
Classification
Indications
Topical anaesthesia for shortterm procedures e.g. Goldmann applanation tonometry, gonioscopy,minorsurgery.
Contraindications
Hypersensitivitytotetracaineorotherestertypeanaesthetics. In view of the immaturity of the enzyme system which metabolises the ester type local anaestheticsinprematurebabies,tetracaineshouldbeavoidedinthesepatients.
Cautions
The eye should be protected from foreign bodies and rubbing during the period of anaesthesia (up to 30 minutes). Ideally the patient should not leave the practice until cornealsensationhasreturned.
Pregnancy risk category C. No well controlled clinical trials have been conducted in pregnancy and lactation. Tetracaine should not be used unless considered essential by the clinician.
Interactions
Tetracaineshouldnotbeusedinpatientstakingsulphonamides.
143
OcularSideEffects
Transientstinging Transientblurring Punctatekeratitis Conjunctivalhyperaemia
A severe, immediatetype apparently hyperallergic corneal reaction may rarely occur. This includes acute, intense and diffuse epithelial keratitis; a grey groundglass appearance and sloughingoflargeareasofnecroticepithelium.
GeneralSideEffects
Dose
Adults&children(1monthandover).1or2dropsissufficienttoanaesthetisethesurfaceof theeyetoallowtonometryorforeignbodytoberemovedfromthecornealepithelium.
Storage
144
Tetracycline

LegalClassification
Tetracycline:tablets,250mgtetracyclinehydrochloride(Nonproprietary)
DrugType
Antiinfective.
Classification
Antibacterial.
Indications
Tetracycline has been found to be clinically effective in the treatment of a variety of infections caused by susceptible strains of Grampositive and Gramnegative bacteria and certainothermicroorganisms.SeeClinicalManagementGuidelineonBlepharitisandOcular Rosacea.
Contraindications
Hypersensitivity to tetracycline or component of the preparation. Hypersensitivity to any other members of the tetracycline family. Tetracycline is contraindicated in children less than12yearsofageandinpregnantornursingwomen.
Cautions
Use with caution in patients with renal or hepatic impairment. May cause photosensitivity and patients should use skin protection, avoid prolonged exposure to sunlight and advised not use tanning equipment. A few cases of pregnancy have been attributed to the use of tetracycline antibiotics with oral contraceptives. Patients taking contraceptives containing oestrogenshouldbewarnedthatthereisapossibilityofcontraceptivefailureandadvisedto use alternative forms of contraception during treatment. Use with caution in patients with SLEormyastheniagravisastetracyclinesmayexacerbatetheseconditions.
Pregnancy risk category D: contraindicated in pregnancy. Animal studies have shown that tetracyclines cross the placenta and can cause toxicity to the foetus. Yellowbrown discolouration of the teeth and enamel hypoplasia can occur when drugs of the tetracycline
family are administered after the first trimester of pregnancy. Tetracyclines are excreted intobreastmilkandthereforecontraindicatedinnursingmothers.
145
Interactions
Antacids and preparations containing aluminium, calcium, magnesium, zinc, bismuth or iron may decrease the absorption of tetracycline. Tetracyclines decrease plasma prothrombin activity and a dose reduction in patients taking anticoagulants may be necessary. Tetracyclinesmayreducetheeffectoforalcontraceptives(seecautions).
OcularSideEffects
GeneralSideEffects
Gastrointestinaldisturbancese.g.nausea,vomitinganddiarrhoea Discolourationofteethandenamelhyoplasia(youngchildren) Abnormalbonegrowth(youngchildren) Headache Photosensitivity Benignintracranialhypertension
Gastrointestinaldisturbancesarecommonlyreported.Thepresenceofheadachesandvisual disturbancemayindicatebenignintracranialhypertension(discontinuetreatment).
Dose
Forblepharitisandocularrosacea:treatmentmayneedtobecontinuedforseveralweeksor months. Adults:2x250mgtabletstwicedaily. Contraindicatedinchildren.
Storage
Storebelow25C.
146
Tropicamide Hydrochloride

LegalClassification
POM:Foruseandsupplybyalloptometrists.
Mydriacyl:eyedrops,0.5%tropicamidehydrochloride(Alcon) Mydriacyl:eyedrops,1.0%tropicamidehydrochloride(Alcon) SingleUse(Preservativefree): MinimsTropicamide:0.5%tropicamidehydrochlorideeyedrops(Bausch&Lomb) MinimsTropicamide:1.0%tropicamidehydrochlorideeyedrops(Bausch&Lomb)
DrugType
Classification
Antimuscarinic.
Indications
Mydriasis(shortduration)andcycloplegicrefraction(inpatientsinlateteensorolder).
Contraindications
Hypersensitivity to tropicamide or any component of the preparation. Contraindicated in patients with confirmed or suspected narrowangle glaucoma as an acute attack may be precipitated. Multidose preparations contain benzalkonium chloride and should not be used where soft contactlensesareworn.
Cautions
Should be used with caution in very young children (particularly neonates) (use 0.5% strength). Because of the risk of precipitating angleclosure glaucoma in the elderly and others prone toraisedintraocularpressure,anestimateofthedepthoftheangleoftheanteriorchamber should be made before use. Darkly pigmented irises are more resistant to pupillary dilation andcautionshouldbeexercisedtoavoidoverdosage. Patientsshouldnotdriveforatleast2hoursfollowingtheinstillationoftropicamide.
147
Pregnancy risk category C. There is insufficient evidence as to the safety of tropicamide in pregnancy or lactation. Tropicamide should be used during pregnancy only when it is consideredessentialbytheclinician.
Interactions
The effect of antimuscarinic agents may be enhanced by the concomitant administration of other drugs with antimuscarinic properties such as amantadine, some antihistamines, butyrophenones,phenothiazinesandtricyclicantidepressants. In the case of concomitant use of another topical eye preparation, allow 510 minutes betweenapplicationsofeachpreparation.
OcularSideEffects
Transientstinging Transientblurring Photophobia Raisedintraocularpressure
Local irritation, hyperaemia, oedema and conjunctivitis may occur following prolonged administration.
GeneralSideEffects
CNSdisturbances Drymouth
Theoretical risk of systemic anticholinergic effects. CNS disturbances have been reported in children.Sideeffectsmorecommoninchildrenwithblondehairandblueeyes.
Dose
Adults&children(3monthsandover). Mydriasis: 1 drop followed by a second drop after an interval of 5 minutes. A further drop maybeinstilledafter30minutes,ifrequired. Cycloplegicrefraction:1drop(1%)followedbyaseconddropafteranintervalof5minutes.
Storage
Storebelow25C.Mydriacylstored28C.Protectfromlight.

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CompiledandProducedbyProfessorJohnLawrensonand ProfessorDavidThomsonDepartmentofOptometryand VisualScienceCityUniversityLondon TheCollegeofOptometrists

See Clinical Management Guidelines on Hordeolum, Blepharitis, Conjunctivitis (Bacterial), Dacryocystitis(Chronic),CornealAbrasion,ForeignBody(Subtarsal).

Adults&children(3monthsandover): Forcycloplegicrefraction:use1drop2timesperdayfor13daysbeforerefraction. Foruveitis:use1drop12timesperday. Foralleviationofciliaryspasm:use1dropevery34hours.

Lid Care Products

Lidocaine Hydrochloride (Lignocaine)

Oxybuprocaine Hydrochloride (Benoxinate)

Paraffin, Yellow, Soft

Propamidine Isetionate/ Dibromopropamidine Isetionate

whether propamidine (or dibromopropamidine) is excreted in breast milk. It should thereforebeusedwithcautioninnursingmothers.

Propylethylene Glycol 400

Tetracaine Hydrochloride (Amethocaine)

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