Dry Eye Prescribing - Guidelines for use in a Primary Care Setting

Publication: 08/03/2016  
Next review: 30/09/2025  
Clinical Guideline
CURRENT 
ID: 4529 
Approved By: LAPC 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Dry Eye Prescribing – Guidelines for use in a Primary Care Setting

General Advice for Dry Eye Symptoms

Try to minimise environmental factors by taking regular breaks from working on VDUs and increasing humidity of rooms where possible. Review medications that may aggravate dry eyes e.g. antihistamines. Ask about OTC medication. Treat underlying condition. Blepharitis is the most common Meibomian Gland Dysfunction (MGD) producing dry eye symptoms. Dry eye is one of the self-care conditions for which eye drops are available OTC and should not be routinely prescribed in primary care. (Leeds CCG Guidance). Treatment should include applying warmth using ‘eye bags’ (available over the counter) and eyelid hygiene. Patient self help guide. There is some evidence that a diet rich in omega-3 fats may improve symptoms. Patients with symptoms suggestive of Sjogren's syndrome should be referred for ophthalmologist review.

Staged Management and Treatment of Dry Eye Symptoms

Step 1
  • Patients generally have mild discomfort or episodic discomfort under environmental stress. No visual symptoms or episodic mild fatigue.
  • Provide general advice as outlined above. Emphasise the importance of lid hygiene.
  • Recommend ocular lubricants OTC containing carbomer or hypromellose. See formulary table below.
  • If patient wears contact lens*, or has sensitivity to preservatives, or applies more than 8 drops a day: use preservative-free (PF) drops. See formulary table below.
  • If blepharitis or evaporative dry eye: use Systane Balance (propylene glycol 0.6%) or Optive Plus (carboxymethylcellulose 0.5%, glycerine 1%, castor oil), 10ml, 6m expiry.
 
Step 2
  • If above options are inadequate;
  • For patients with moderate episodic or chronic discomfort with or without environmental stress. Episodic visual symptoms which are annoying and/or activity-limiting.
  • Consider preservative-free (PF) treatment options containing carmellose or sodium hyaluronate. See formulary table below.
  • Recommend overnight treatment with a paraffin-based PF eye ointment: Xailin Night or Hylo-Night (formerly known as VitA-POS) or HydraMed Night Eye Ointments, 5g.
  • Hydroxypropyl guar or combination product containing trehalose can be used for more severe symptoms as they can reduce inflammation and protect ocular surface.
Steps 3 & 4
  • If above options are inadequate;
  • If there is any signs of inflammation;
  • For patients who are allergic to lanolin, alternative lanolin-free eye ointment can be obtained from specialist.
  • Refer to secondary care.

 

Formulary Table

Stages /
Treatment Option
Step 1 (Recommend to buy OTC) Step 2 (Use qds + prn up to every hour if required)
1st line

Carbomer ‘980’ 0.2% eye drop, use qds prn (longer acting and more viscous than hypromellose);

OR

Hypromellose 0.3% eye drop, use frequently prn. Consider switching to PF drops if using more than 8 times a day.

Carmellose 0.5% or 1% PF eye drops, 10ml (preservative free squeeze bottle device).

Prescribe generically or use most cost effective brand. For e.g. VIZcellose** 0.5% or VIZcellose** 1% PF eye drops. 10ml, 3m expiry.

2nd line
(If 1st line inadequate or intolerant)
Sodium hyaluronate 0.1% - 0.2% eye drops. Use most cost effective brand. For e.g. Blink Intensive Tears. Consider switching to PF drops if using more than 8 times a day.

Sodium hyaluronate 0.1% - 0.2% PF eye drops. Prescribe most cost effective brand, assess patient’s dexterity for choice. For e.g.:

- Hyabak** 0.15% PF eye drop. 10ml, 3m expiry.

- Hylo-Tear*** 0.1% or Hylo-Forte*** 0.2%. 300 drops metered dose bottle, 6m expiry. Can prescribe ComplEYE aid.

- VIZhyal** 0.1% or 0.2% PF eye drops. 10ml, 6m expiry.

If a more viscous drop is required, use Clinitas Multi** 0.4% (sodium hyaluronate) PF eye drop. 10ml, approx. 200 drops, 3m expiry.

Alternative options (If all above inadequate) - Systane (hydroxypropyl guar) PF eye drop. 28 x 0.8ml.
- Thealoz Duo** (trehalose 3% and sodium hyaluronate 0.15%) PF eye drop. 10ml, 3m expiry.
Overnight
treatment
Xailin Night or Hylo-Night (formerly known as VitA-POS) or HydraMed Night Eye Ointments. 5g, preservative free, check individual preparation for expiry date.
Evaporative dry eye / blepharitis Systane Balance (propylene glycol 0.6%) or Optive Plus (carboxymethylcellulose 0.5%, glycerine 1%, castor oil). 10ml, 6m expiry, contains preservative.

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Provenance

Record: 4529
Objective:
Clinical condition:

Dry Eyes Symptoms

Target patient group:
Target professional group(s): Primary Care Doctors
Secondary Care Doctors
Adapted from:

Evidence base

References

(1) NHS Scotland. 2018. Scottish Dry Eye Guidelines. Version 1.1.

(2) TFOS DEWS II Report Executive Summary. 2017. The Ocular Surface. 15. pp.802-812.

(3) TFOS DEWS II Management and Therapy Report. 2017. The Ocular Surface. xxx. pp.580-634.

* Usual advice to soft contact lens wearers is that preservative free drops must be used unless the wearer is able to remove the lens and not replace for at least 30 minutes after instilling preserved drops.

** These products have a 0.2 micron filter system in place to preserve sterility, one example being the Thea ABAK system. This prevents bacteria being drawn back into the bottle. The sides of the bottle are squeezed to release the drop.

*** Uses the COMOD system. Patient must press the base of the bottle to release one measured dose. You can also prescribe the ComplEye aid which assists administration of the drops and prevents the tip touching the eye.

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Approved By

LAPC

Document history

LHP version 3.0

Related information

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