OCULAR LUBRICANTS FLOWCHART

Mild dry eyes (Grade 1)

Hypromellose 0.5% or Carbomer QDS + ointment (e.g. Lacri-Lube®) at night:

Hypromellose 0.5%
Carbomer 980 0.2% e.g. Viscotears

Preservative free (if patient intolerant to preservatives / unsuitable for preservatives e.g. already on frequent preserved eye drops for co-existing ocular conditions)

Polyvinyl alcohol e.g. Refresh Ophthalmic®

Moderate dry eyes (Grade 2)

Preservative free preparation (6≥) + ointment (e.g. Lacri-Lube®) at night:

Multidose bottle - preservative free

Sodium hyaluronate (e.g. Hyabak® 0.15%; Hylo-Forte® 0.2%+ ComplEye aid)

Single dose units – preservative free

Polyvinyl alcohol e.g. Refresh Ophthalmic®
Hydroxypropyl-guar (e.g. Systane®)
Carmellose (e.g. Celluvisc® 1% or if not tolerated 0.5%)

Severe dry eyes (Grades 3 or 4)

Refer to Cornea and External Eye Disease Clinic

Patients may need the following in addition to / instead of any of the above-mentioned lubricants:

Sodium hyaluronate (e.g. Vismed® 0.18%, Clinitas® 0.4%)
Acetylcysteine 5% - 10% preserved and preservative free RESTRICTED to CORNEAL CONSULTANTS only (SPECIALS)
Anti-inflammatory agents e.g. Ketorolac

Created by: Anar Meghji, Dispensary Pharmacist; Ratified by : Lucy Titcomb, Directorate Pharmacist

IMPORTANT

Please remember to prescribe HYLO-FORTE®with a ComplEye aid. When Hylo-Forte® is used with a ComplEye aid -we recommenda 6 month expiry, without a ComplEye aid we reduce the expiry to 28 days as there is more potential for contamination.

Please remember you can also prescribe the following sodium hyaluronate products in accordance with the lubricant guidelines (attached) – on the ward, in casualty and in clinic:

Sodium Hyaluronate 0.15%( multidose preservative free) – HYABAK®- 8 week expiry on opening(NOT advisable for inpatient prescribing) [Both Hylo-Forte® and Hyabak® are NOT advisable for inpatient prescribing as the in use shelf-life for these products would be only 14 days on the inpatient ward(as for all eye drops used on the wards). ]

Sodium Hyaluronate 0.18% (single dose preservative free) – VISMED®

Sodium Hyaluronate 0.4%(single dose preservative free) - CLINITAS®

Please note that Hylo-Care®, Hylo-Tear®, Oxyal®, Vismed Multi®, Optive®, Systane Ultra® are NON FORMULARY and must NOT be prescribed, on FP10 or otherwise.

Should you have any further queries, do not hesitate to contact us on ext 6717 / 6716.