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Summary

Summary BNF Chapter 11 Notes - Eyes

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A very concise set of notes covering the important aspects of ocular drugs & diseases required to pass the GPhC exam. Topics include: - Preservatives - Contact Lenses - Conjunctivitis - Ocular anti-inflammatories - Ocular Mydriatics - Glaucoma

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  • November 12, 2023
  • 6
  • 2022/2023
  • Summary

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OPHTHALMIC PREPEARTIONS – Eye drops, gels, ointments

TYPES OF OPHTHALMIC PREPS:
1- Eye Drops – preservative and preservative free (PF):
- Preservatives are needed to prevent microbial contamination of drops
- Preservatives are also toxic to sensitive corneal cells  irritation & dryness
- If a pt has to administer drops > 4x daily – use PF forms to prevent irritation
- PF forms are typically UNIT DOSE (vials) – but some newer forms are MULTI-DOSE PF

2- Eye Gels & Ointments:
- Typically reserved for more SEVERE dry eye conditions
- Longer onset of action – but also have longer duration (more effective long-term)
- Thickness of these formulations  more blurred vision (so typically used at night)

ADMINISTERING OPHTHALMIC PREPS:
- Generally, eye drops, gels & ointments are applied the SAME WAY:
1- Instil drop/gel/ointment in pocket formed in lower eyelid
2- Blink a few times to allow even distribution
3- Close eyes for ~ 30 secs – 1 minute whilst pressing against inner corner of eye
(more absorption into eye & less absorption into nasopharynx  systemic abs)

- If using different types of drops together – WAIT 5 MINS between doses (otherwise
the 2nd drop will wash out the 1st drop)
- Eye ointments are always administered AFTER other eye preps
- Typically, only ONE drop of an eye prep is required per dose – using multiple doses at
the same time  overflow out of eye  waste of product

EYE DROP COMPLIANCE AIDS:
- Compliance aids: devices which help patients administer drops
effectively
- WHO IS THIS AIMED AT:
o Poor manual dexterity (e.g. arthritis, Parkinson’s)
o Impaired vision (e.g. glaucoma, cataracts)

Some are product-specific, some are available on NHS – more info on Moorfields Eye
Hospital website (patient-friendly):
https://www.moorfields.nhs.uk/sites/default/files/Eye%20drop%20compliance%20aids.pdf

CONTACT LENSES, PRESERVATIVES, EXPIRY DATES

OVERVIEW:
- TWO MAIN TYPES:
o Hard (RGP) – individualised to eyeball  better visual acuity (but less comfy)
o Soft – one size fits all  not as good as hard lenses (but comfier)
- NEVER wear contacts to sleep (unless they’re designed for that purpose)
- Important that pt knows how to change & clean contacts (& how often to do so)

Keratitis (non-infectious & infectious) is the MOST common complication of improper lens use –
other complications include conjunctivitis and dry eyes

, CONTACTS & OPHTHALMIC PREPS:
- Generally, POM & P drops should NOT be used with contacts (soft & hard) – WHY:
o Preservatives accumulate in lens  corneal irritation
o Some drops are viscous/oily  accumulate in lens  discolouration/blurring
- If pt has to use drops that are NOT compatible – instil drop then wait 15 mins
before wearing contacts (or until infection has cleared)

- Only Lubricating & Rewetting drops can be used w/ contacts if they’re PF:
o Lubricating drops: lubricates the eye itself (tend to be more oily)
o Rewetting drops: moistens the contact lens (so lens soaks up less
moisture/tears from the eye  less dryness & irritation)

Always check w/ manufacturer if a drop is compatible with contacts e.g. Hylo Forte
NEVER use gels/ointments w/ contacts – too oily



Why Hylo-Tear/Forte is good (but more expensive)

- PF: safe to use whilst wearing contacts
- Maintains sterility for 6 months (not 28 days)
- Uses a similar mechanism to nasal sprays (press down on
plunger) – releasing a single drop at the same velocity per
dose (very accurate)




CONTACTS & SYSTEMIC MEDS:
- Some oral/systemic meds should be used with CAUTION with contacts:
o Sulfasalazine  yellow discolouration of contacts
o Rifampicin  red-orange discoloration of contacts
o Antihistamines & Antimuscarinics (including TCAs)  less lacrimation  XS
dryness & irritation
o Aspirin  readily excreted into tears  corneal irritation

EYE DROP SHELF-LIFE AFTER OPENING: (to maintain sterility)
- If pt has been prescribed multi-dose bottle for HOME or HOSPITAL use:
o Bottle should be discarded FOUR WEEKS after opening (unless otherwise
stated by manufacturer e.g. Hylo-Tear)

- If pt has to be given drops in SPECIALIST SETTING (including in EYE SURGERY):
o Single-use (UD) drops should be used – OR discard the multi-dose bottle after
ONE USE




EYE CONDITIONS (SEE BELOW)

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