Tear deficiency, ocular lubricants, and astringents (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

For advice on the prescribing and use of tear substitutes, refer to table below and Dry Eye Syndrome guidance.

  • many of these products are available over the counter see Pharmacy First
  • base the choice of tear substitute on patient acceptability and cost.
  • acetylcysteine is a mucolytic and is useful for patients with painful eyes due to mucous keratopathy.
TOPICAL LUBRICANTS/TEAR SUBSTITUTE
Note: with frequent use many patients will require more than 10mL per month.
First line
  • hypromellose eye drops 0·5% (Isopto Plain®) or 1% (Isopto Alkaline®)
  • polyvinyl alcohol eye drops 1·4% (Sno Tears®, Liquifilm®)
Second line
  • carbomer gel 0·2%, for list of products see BNF
  • consider ointment at night, eg Xailin Night® or Hylo Night®
Third line

Rapid breakdown preserved agents; may be suitable in preservative intolerance; suitable for contact lens wearers:

  • Blink® Intensive Tears (sodium hyaluronate eye drops 0·2%) (10mL)
  • Oxyal® (sodium hyaluronate eye drops 0·15%) (10mL)
  • Systane® (hydroxypropyl guar eye drops) (10mL)
Fourth line/ preservative free (PF)
  •  sodium hyaluronate eye drops (PF) 0·1% to 0·2%
    • Vismed® Multi 0·18% (10mL) shelf life: 1 month after opening
    • Hylo-Tears® 0·1% (10mL) shelf life: 6 months after opening
    • Hylo-Forte® 0·2% (10mL) shelf life: 6 months after opening
  • sodium hyaluronate eye drops (PF) 0·4%
    • Clinitas® 0·4% (30 resealable vials, re-use for 12 hours)
  • carmellose eye drops 0·5% (Celluvisc® 0·5% single use 30 units)
  • carmellose eye drops 1% (Celluvisc® 1% single use 30 units)
  • polyvinyl alcohol eye drops (PF) 0·4% (Liquifilm® PF single use 30 units)

 

ACETYLCYSTEINE

Therapy notes

Formulation and dosage details

Formulation:

Eye drops (acetylcysteine 5%, hypromellose 0·35%) (Ilube®) (specialist use only)

Dosage:

Apply 1 drop 3 to 4 times daily.

CARBOMERS

Therapy notes

Carbomers are useful and they are low cost.

Formulation and dosage details

Formulation:

Eye drops 0·2% (Viscotears®)

Dosage:

Apply 1 drop 3 to 4 times daily or as required.

HYDROXYPROPYL GUAR WITH POLYETHYLENE GLYCOL AND PROPYLENE GLYCOL

Therapy notes

Formulation and dosage details

Formulation:

Eye drops (polyethylene glycol 400 0·4%, propylene glycol 0·3%, hydroxypropyl guar) (Systane®)

Dosage:

Apply as required.

HYPROMELLOSE

Therapy notes

Formulation and dosage details

Formulation:

Eye drops 0·3%, 0·5% (Isopto Plain®), 1% (Isopto Alkaline®) 

Dosage:

Apply 1 drop 3 to 4 times daily, may need to increase frequency to hourly for adequate relief. The higher strength preparations may be more effective and are lower cost; it is recommended that new patients are started on the 0·5% strength.

LIQUID PARAFFIN WITH WHITE SOFT PARAFFIN AND WOOL ALCOHOLS

Therapy notes

Formulation and dosage details

Formulation:

Eye ointment (Xailin Night®)

Dosage:

Apply at night or if required up to 4 times daily throughout the day.

POLYVINYL ALCOHOL

Therapy notes

Formulation and dosage details

Formulation:

Eye drops 1·4% (Sno Tears®, Liquifilm Tears®)

Dosage:

Apply 1 drop 4 times daily, increasing to every hour if required.

RETINOL PALMITATE WITH WHITE SOFT PARAFFIN, LIGHT LIQUID PARAFFIN, LIQUID PARAFFIN AND WOOL FAT

Therapy notes

Formulation and dosage details

Formulation:

Eye ointment, preservative free (Hylo Night®) (previously Vita-POS)

Dosage:

Apply at night or if required up to 4 times daily throughout the day.

SODIUM HYALURONATE

Therapy notes

Formulation and dosage details

Formulation:

Eye drops 0·15% (Oxyal®), 0·2% (Blink® Intensive Tears)

Dosage:

Apply as required. Usually initiate therapy with 0·1% to 0·2% and consider higher strength if unsatisfactory response.

Editorial Information

Document Id: F208