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11.8 Miscellaneous ophthalmic preparations

Click here for the trust 'Dry eye guidelines'


11.8.1 Tear deficiency, ocular lubricants and astringents

Acetylcysteine hypromellose (Ilube or Euronac) drops
Carmellose Sodium (Celluvisc) eye drops 0.5% (preservative free)
Carmellose Sodium (Optive or Optive plus) eye drops 0.5%
Hydroxyethylcellulose (Artificial Tears) minims
Hydroxypropyl guar (Systane) drops - mild-moderate tear deficiency
Hypromellose drops
Liquid paraffin ointment (Lacri-Lube)
Polyvinyl alcohol (Sno Tears) drops
Sodium chloride minims, ointment
Sodium hyaluronate (Evolve-HA®) drops - severe tear deficiency
Sodium hyaluronate 0.1%, carmellose 0.5% (Optive fusion)
Systane Balance
Systane Ultra
Viscotears liquid gel, minims
Xailin Night eye ointment
Xailin Fresh 0.5%


1. Carmellose eyedrops (preservative free) - are restricted to patients with severe dry eyes who are allergic to preservatives or have evidence of corneal damage

2. Ilube / Euronac is useful for patients with filamentary keratitis.

3. Xailin Night may be used as an alternative to Lacri-Lube.

4. The local CCG guideline on the management of dry eyes can be found here 


11.8.2 Ocular diagnostic and peri-operative preparations

Fluorescein sodium minims
Acetylcholine Miochol solution for irrigation
Apraclonidine 0.5%, 1% ophthalmic solution (single dose units).
Ketorolac trometamol (Acular)
Nepafenac ophthalmic suspension (RED drug)
Verteporfin infusion (specialist use only)
Bevacizumab (intravitreal)
Ranibizumab (intravitreal)
Aflibercept (intravitreal)
Ocriplasmin (intravitreal)
Fluocinolone (intravitreal)


 See NICE TA 68: Photodynamic therapy (PDT) for wet age-related macular degeneration (ARMD)

See NICE TA 155: Pegaptanib and ranibizumab for the treatment of wet age-related macular degeneration

See NICE TA 274: Ranibizumab for treating diabetic macular oedema

See NICE TA 283: Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion

See NICE TA 294: Aflibercept for treating wet age-related macular degeneration

See NICE TA 297 Ocriplasmin for treating vitreomacular traction in adults

See NICE TA 298 Ranibizumab for choroidal neovascularisation associated with pathological myopia

See NICE TA 301 Fluocinolone for chronic macular oedema

See NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary central retinal vein occlusion

See NICE TA 346 Aflibercept for treating diabetic macular oedema


1. Ketorolac is consultant initiated only.

2. Please note it is only to be used for patients who are steroid responders (patients who have sudden increase in intra-occular pressure following the use of topical steroids) AND who are post op or who have herpes simplex keratitis (unlicensed indication). It is also only licensed for 3 weeks only.

3. Apraclonidine is consultant initiated, hospital use only (RED drug).

4. Apraclonidine 0.5% ophthalmic solution is indicated for short term adjunctive therapy of chronic glaucoma in patients on maximally tolerated medical therapy, who require additional reduction of IOP to delay laser treatment or glaucoma surgery.

5. Apraclonidine 1% ophthalmic solution is indicated to control or prevent post-surgical elevations in IOP that occur in patients after anterior segment surgery (maximum 1-2 doses as per SPC).

6. Bevacizumab (invitreal) is for use pre-victrectomy in patients with severe proliferative diabetic retinopathy 1 week prior to surgery to reduce vascularity of retina, and to reduce the incidence of post-operative vitreous haemorrhage and the need for diathermy. 

For link to BNF section: 11.8 Miscellaneous ophthalmic preparations