11.8.1 Tear deficiency, ocular lubricants, and astringents

Most products can be purchased over the counter at a cost less than the prescription charge

Selection of product is based upon viscosity which increases in the order:

hypromellose - polyvinyl alcohol - carbomer

Patients with more severe disease such as Sjögren's syndrome usually require more viscous products.

Hypromellose should be prescribed generically. The 0.3% is standard; other strengths should be reserved for specialist recommendation.

Due to the need for frequent installation of these products, the development of allergy to preservative can occur. Preservative allergy is usually diagnosed by an ophthalmologist and may necessitate a change of lubricant as outlined above. Lacri-Lube® ointment is preservative free but contains lanolin and wool fat.

Product selection is based upon the lowest acquisition cost within each class.

Drugs used for dry eye disease not listed here:

Polyvinyl alcohol
  • Sno Tears® eye drops 1.4% (£1.06 = 10ml)

Indications

  • Dry eye conditions

Dose

  • Apply as required, up to six times a day
Hypromellose
  • Eye drops 0.3% (£0.94 = 10ml)

Indications

  • Dry eye conditions

Dose

  • Apply one drop as required, up to 6 times daily

Notes

  1. 0.3% is standard; other strengths should be reserved for specialist recommendation
Carbomers
  • Viscotears® carbomer 980 0.2% ophthalmic liquid gel (£2.80 = 10g)

Indications

  • Dry eye conditions

Dose

  • Apply one drop 3-4 times daily or as required (maximum 6 times daily)
Liquid paraffin
  • VitA-POS® eye ointment (£2.75 = 5g)
  • Lacri-lube® eye ointment (£3.98 = 5g)

Indications

  • Dry eye conditions

Dose

  • Apply a small strand of ointment to the eye, once daily, before going to bed

Notes

  1. May cause temporary visual disturbance so best suited for application before sleep
  2. May be used in combination with artificial tear drops during the day
  3. Paraffin containing products should not be used in contact lens wearers
  4. Some preparations contain lanolin and wool fat
  5. Some products have extended expiry dates – refer to individual manufacturer details

Preparations for patients with preservative allergy

Polyvinyl alcohol
  • Liquifilm Tears® single use eye drops 1.4% (£5.35 = 30 units)

Indications

  • Dry eye conditions in patients with preservative allergy

Dose

  • Apply as required
Hypromellose
  • Evolve® Hypromellose eye drops 0.3% - preservative free (£1.98 = 10ml)
Carbomers
  • Viscotears® carbomer 980 0.2% ophthalmic liquid gel single dose units (£5.42 = 30 units)

Indications

  • Dry eye conditions in patients with preservative allergy

Dose

  • Apply one drop as required
Carmellose
  • Celluvisc® single use eye drops 0.5% - preservative free (£4.80 = 30 units)
  • Evolve® Carmellose eye drops 0.5% -preservative free (£4.99 = 10ml)

Indications

  • Dry eye conditions

Dose

  • Apply as required
Sodium Hyaluronate
  • Clinitas® single use eye drops 0.4% - preservative free (£6.99 = 30 units)
  • Evolve® HA eye drops 0.2% - preservative free (£5.99 = 10ml)

Indications

  • Dry eye conditions

Dose

  • Apply as required

Notes

  1. Sodium hyaluronate is more expensive than other ocular lubricants but maybe more cost effective for patients who do not use an entire bottle every month as the drops remain sterile in the bottle for longer than 28 days after opening. Please refer to the individual product information and remind patients not to dispose of the bottle after 28 days
  2. Clinitas®: each vial is re-closable and can be used for up to 12 hours after opening. Please counsel patients on the correct use and that the re-closable vials must not be discarded after the first use.

 

Home > Formulary > Chapters > 11. Eye > 11.8 Miscellaneous ophthalmic preparations > 11.8.1 Tear deficiency, ocular lubricants, and astringents

 

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