11.8 Tear deficiency and diagnostic stains

11.8.1 Preparations for tear deficiency

Eye drops
First Choice:
hypromellose 0.3% eye drops
Second Choice:
carbomer 980 (Viscotears®) eye drops
Eye ointment
First Choice:
Lacri–Lube ®eye ointment
Formulations/Dose
  • hypromellose 0.3% eye drops
    • All ages, apply one drop as frequently as required e.g. hourly.
  • carbomer 980 (Viscotears®) 0.2% liquid gel (eye drops)
    • All ages, apply 3-4 times daily or as required.
  • Lacri–Lube® eye ointment
    • All ages, usually applied at night. It can however be used during the day in cases of persistent corneal epithelial erosion, but it will blur the vision. All available lubricant eye ointments (Lacri–Lube®, Lubri–Tears®, Simple eye ointment) contain lanolin.
Prescribing Notes
  • These preparations are available over–the–counter.
  • Chronic soreness of the eyes due to reduced / abnormal tear secretion often responds to tear replacement therapy. The severity of the condition and patient preference will often guide the choice of preparation.
  • Frequent instillation of drops (e.g. hourly hypromellose) may cause a sensitivity reaction to the preservative in the drops. There are several preservative–free artificial tear preparations available e.g. Artificial Tears Minims®, Liquifilm Tears® single dose units. There is also a relatively cheap multi–dose hypromellose preservative– free available from Moorfields (bottle keeps for 1 week in the fridge after opening). Hypromellose eye drops is the traditional choice of treatment for tear deficiency. It is the cheapest and the least viscous.
  • Acetylcysteine 5% with hypromellose 0.35% (Ilube®) drops is useful as a mucolytic agent.
11.8.2 Occular diagnostic stains

First Choice:
fluorescein
Formulations/Dose
  • fluorescein ophthalmic strips (Fluorets®)
    • Moisten with sterile saline before use.
  • fluorescein eye drops 1% or 2% (Minims® Fluorescein Sodium)
    • All ages, apply sufficient solution to stain the damaged areas.
Prescribing Notes
  • Fluorescein ophthalmic strips are used to detect corneal abrasions/lesions and foreign bodies. They are also used in tonometry.
  • Fluorescein eye drops are used for diagnosis of naso–lachrymal duct patency.
  • For detection of corneal abrasions, strips are preferred since the drops may not fluoresce properly if too much is instilled into the eye.
Other eye preparations

For specialist use only:

  • Mydricaine No. 2 injection should not be used in children. Mydricaine No. 1 injection (children) is used for rapid dilation of the pupil in iritis and uveitis. Dose: up to 0.3mL by subconjunctival injection. Each 0.3mL of No. 1 injection (children) contains procaine HCl 3mg, atropine sulfate 0.5mg, and adrenaline solution (1 in 1000) 0.06mL.
'Special-order' manufacturers

All preparations manufactured by ‘special–order’ manufacturers should be prescribed in the normal way on GP10. The pharmacist can obtain the preparation from one of the following:

 

(a)
Tayside Pharmaceuticals
(b)
Pharmacy Production Unit
Production Department
University Place
Ninewellsl Hospital
Western Infirmary
Dundee
Glasgow
DD1 9SY
G11 6NT
Tel: 01382 632 052
 
Tel: 0141 211 2755
(c)
Moorfields Eye Hospital NHS Trust
(d)
Martindale Pharmaceuticals
City Road
Hubert Road
London
Brentwood
EC1V 2PD
Essex
Tel: 0207 684 8561/2
CM14 4LZ
Fax: 0800 328 8191