netFormulary George Eliot Hospital NHS
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 Formulary Chapter 11: Eye - Full Chapter

Chapter complete - updated July 18

11.06  Expand sub section  Treatment of glaucoma

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
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

Miotic works by openeing the inefficient drainage channels in the trabecular meshwork. Pilocarpine is not commonly used for the treatment of primary open-angle glaucoma because side effects are poorly tolerated (headache is a frequent symptom in the first fornight of treatment and it causes a small pupil, which can compromise visual acuity). It is used mainly in the treatment of primary angle-closure glaucoma and secondary glaucomas.

Pilocarpine 1%, 2% & 4% eye drops
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Green SA

Please note that 4% strength are SPECIALIST ONLY 
note Notes
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Unlicensed Drug
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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]