Tear deficiency, ocular lubricants, and astringents (Formulary)

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) self 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

Important: Therapy notes

Important: 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

Important: Therapy notes

Carbomers are useful and they are low cost.

Important: 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

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

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

Dosage:

Apply as required.

HYPROMELLOSE

Important: Therapy notes

Important: 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

Important: Therapy notes

Important: 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

Important: Therapy notes

Important: 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

Important: Therapy notes

Important: 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

Important: Therapy notes

Important: 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