11.1 Administration of drugs to the eye
|First line drugs||Second line drugs||Specialist drugs||Secondary care drugs|
- Eye drops and eye ointments are generally instilled into the pocket formed by gently pulling down the lower eyelid and keeping the eye closed for as long as possible after application, preferably 1-2 minutes; one drop is all that is needed. A small amount of eye ointment is applied similarly; the ointment melts rapidly and blinking helps to spread it.
- When two or more different eye-drop preparations are used at the same time of day, or ointment at the same time as drops, the patient should leave an interval of 5 minutes between preparations to avoid dilution and overflow.
- Certain preparations included within this formulary are unlicensed Unlicensed. These products will be ordered specially and are not stocked; therefore a delay in obtaining stocks may be incurred. These ‘specials’ may be supplied when clinical need for the individual patient demands, given no commercial alternative is available. Specials are often very costly.
Eye drop dispensers are available to aid the instillation of eye drops especially amongst the elderly, visually impaired, arthritic, or otherwise physically limited patients; they may be useful in children in whom normal application is difficult. Eye drop dispensers are for use with plastic eye drop bottles, for repeated use by individual patients. They can be purchased from most community pharmacies or prescribed on a FP10 prescription. Please refer to the Drug Tariff for details – Appliances: Eye Drops Dispensers.
Preservatives and sensitisers
- Long-term administration of preservative containing eye drops may cause ocular irritation.
- The Plymouth Royal Eye Infirmary (REI) offer the following recommendations for when to use preservative free treatments:
- the patient has an allergy to the preservative
- frequent use of the drops – six or more times a day (long-term use)
- the patient is wearing a soft contact lens or bandage lens at the time of instillation, on specialist advice
- after a corneal transplant in selected cases, depending on indication, and in cases where the cornea is compromised, on specialist advice
- ocular surface disease, including severe dry eye syndrome
- Some patients using preservative-free eye drops in multiple-use containers could be at risk of serious eye infection due to microbial contamination of the product. Doctors should exercise caution when prescribing multiple-use eye drops without preservative in patients at high risk of infection.
- All Minims and other single use products are preservative free.
Last updated by: Carol Webb on 22-04-2013 13:22