Administration of drugs to the eye

1. Eye drops and eye ointments are instilled into the pocket formed by gently pulling down the lower eyelid. For eye drops, one drop is all that is needed as long as instillation is successful. For eye ointments, a small amount is applied similarly; the ointment melts rapidly and blinking helps to spread it.

2. When two or more different drops are required at the same time of day, the patient should leave an interval of 5 minutes between drops to avoid dilution and overflow. Also to use ointment preparations 5 minutes after drops.

3. Certain preparations included within this chapter of the formulary are unlicensed and marked with *. These products will be ordered specially and are not stocked; therefore a delay in obtaining stocks may be incurred. These 'specials' may be supplied when clinical need for the individual patient demands, given no commercial alternative is available. Specials are often very costly.

Administration aids: Eye drop dispensers are available to aid the instillation of eye drops especially amongst the elderly, visually impaired, arthritic, or otherwise physically limited patients. They can be purchased from most community pharmacies or prescribed on FP10 prescription. Please refer to the Drug Tariff for details - Appliances: Eye Drops Dispensers.

Preservatives and sensitisers:

1. Long-term administration of preservative containing eye drops may cause ocular irritation.

2. RCHT Eye Unit offer the following recommendations for when to use preservative free treatments:

• the patient has a proven allergy to the preservative
• frequent use of the drops - six or more time a day (long-term use)
• the patient is wearing a soft contact lens or bandage lens at the time of instillation, on specialist advice
• after a corneal transplant in selected cases, depending on indication, and in cases where the cornea is compromised, on specialist advice

3. All Minims^® and other single use products are preservative free.

Administration:

Eye drops (non-viscous) - 1 drop at least every 2 hours. Frequency reduced as infection controlled and to continue 48 hours after healing.

Eye ointment - Apply either at night (if eye drops used during the day) or 3 - 4 times daily (if eye ointment used alone).

2. If there is no response to treatment it is advisable that a swab is taken before changing the antibiotic.

1. Chloramphenicol is the drug of choice for superficial eye infections. It has a broad spectrum of activity and is associated with a low level of resistance. Chloramphenicol ointment is recommended in the treatment of a neonate with sticky eye.

2. Fusidic acid (Fucithalmic^®) is a second line alternative when chloramphenicol is not indicated or inappropriate. Though it may be used first line in staphylococcal infections eg blepharitis. It is applied twice a day.

3. Ciprofloxacin eye drops should be reserved for treatment of sight threatening corneal ulcers.