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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Chapter complete - updated July 18

 Details...
11.06  Expand sub section  Treatment of glaucoma
 note 

Glaucoma described a group of disorders characterised by a loss of visual field associated with cupping of the optic disc and optic nerve damage. While glaucoma is generally associated with raised intra-ocular pressure, it can occur when the intra-ocular pressure is within normal range.
The most common cause of glaucoma is primary open-angle glaucoma (chronic open-angle glaucoma), where drainage of the aqueous humor through the trabeular meshwork is restricted. The condition is ofter asymptomatic, but the patient may present with significant loss of visual field. Patients with ocular hypertension are at high risk of developing primar open-angle glaucoma.
Acute angle-closure glaucoma occurs when the outflow of aqueous humour from the eye is obstructed by bowing of the iris against the trabecular meswork; it is a medical emergency that requires urgent reduction of intra-ocular pressure to prevent loss of vision. Patient with acute angle-closure glaucoma should be referred immediately for specialist opthalmology assessment and treatment.

11.06  Expand sub section  Beta-blockers
 note 

Topical application of a beta-blocker to the eye reduces intra-ocular pressure effectively in primary open-anlge glaucoma, probably by reducing the rate of production of aqueous humour.
Systemic absorption can follow topical application, hence, they are contraindicated in asthma, bradycardia and congestive heart failure.
Full clinical response may take several weeks to occur. Intraocular pressure should be measured approximately four weeks after starting treatment, because of diurnal variations in intraocular pressure, satisfactory response is best determined by measuring the intraocular pressure at different times of the day.

Timolol 0.25% & 0.5% eye drops
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First Choice
Green SA
STEP TWO: Beta-blockers 
Betaxolol 0.25% & 0.5% eye drops (Betoptic)
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Second Choice
Green SA
STEP TWO: Beta-blockers 
   
Levobunolol 0.5% eye drops (Betagan)
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Third Choice
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STEP TWO: Beta-blockers 
   
Carteolol 1% & 2% eye drops (Teoptic)
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Fourth Choice
Green SA
STEP TWO: Beta-blockers 
   
11.06  Expand sub section  Prostaglandin analogues
11.06  Expand sub section  Sympathomimetics
11.06  Expand sub section  Carbonic anhydrase inhibitors and systemic drugs to top
11.06  Expand sub section  Miotics
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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