Related guidance:

Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears Technology appraisal guidance (TA369 December 2015)

Dry Eye 

Refer for same-day specialist assessment if acute glaucoma, keratitis, or iritis is suspected because of:

  • Moderate-to-severe eye pain or photophobia
  • Marked redness of the eye in one eye (consider Optometry Red Eye Service)
  • Reduced visual acuity

Management of Dry Eye Syndrome in Primary Care

  • The condition cannot be cured but symptoms may be relieved and deterioration stopped by simple tear replacement treatment.

Self-care options may be sufficient to avoid the need for treatment.

  • Eyelid hygiene to control the blepharitis that most people with dry eye syndrome have.
  • Limiting the use of contact lenses, if these cause irritation.
  • Stopping medication that exacerbates dry eyes, such as topical and systemic antihistamines.
  • Using a humidifier to moisten ambient air.
  • If smoking tobacco, stopping smoking may help.
  • If using a computer for long periods, ensure that the monitor is at or below eye level, avoid staring at the screen, and take frequent breaks to close/blink eyes.
  • Consider the effects of other medications, e.g Preservatives in topical eye medications, antihistamines, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs).
  • Consider underlying medical and surgical conditions associated with dry eye syndrome, for example: allergic conjunctivitis, Sjögren’s syndrome, facial or trigeminal neuropathy, herpes zoster affecting the eye, chronic dermatoses of eyelids, previous ocular or eyelid surgery, trauma, radiation therapy, burns.

If there is an underlying condition (suspected or known) that can cause dry eyes, consider referral for specialist assessment if that condition is not normally managed in primary care

Treatment Options

Mild symptoms

Dry eye symptoms can usually be managed satisfactorily with lubricant and lipid tear supplement eye drops and lifestyle changes.

Moderate symptoms

Patients may require more frequent use of tear supplements and/or use of a more viscous product.
Symptoms may include some degree of blurred vision and sensitivity to light and could result in restricted activities.

Treatment for dry eyes associated with tear deficiency should normally commence with the least viscous agent, e.g. Hypromellose 0.3% drops and work through alternatives in increasing order of viscosity.

If the most cost-effective choice of eye lubricant(s) are not satisfactory for a patient, after a trial, then all other lubricants can be considered as patient choice is an important factor in the management of dry eye.

Acetylcysteine 5% eye drops should only be used for patients with mucous filaments (as per Ophthalmology advise)

  • Such patients should only require 2-3 months of treatment and then should stop and use standard lubricant.
  • Any patient requiring long term treatment with acetylcysteine eyr drops should be referred back to  ophthalmology.
Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)		Rationale for decision / comments
Ocular lubricants
Hypromellose as AaproMel®0.3% drops £0.69 (10ml)28 day expiry.
as AacuLose®0.3% drops £0.71 (10ml)28 day expiry.
as Lumecare tear®0.3% drops £0.80 (10ml)28 day expiry.
Preservative-free
as Evolve Hypromellose®		0.3% drops: £1.98 (10ml)
3 month expiry.
Carbomeras AaCarb®
0.2% gel: £1.39 (10g)28 day expiry.
as Clinitas Carbomer gel®0.2% gel: £1.49 (10g)28 day expiry.
Preservative-free
as Evolve Carbomer 980®
0.2% gel: £2.70 (10g)

3 month expiry.
Preservative-free
as Ocu-Lube Carbomer 0.2% Eye Gel		0.2% gel: £5.25 (30 x 0.6ml)
Sodium Hyaluronateas Blink Intensive Tears®0.2% drops: £2.97 (10ml) 28 day expiry.
Preservative-free
as Blink Intensive Tears®

0.2% drops: £2.97 (20 x 0.4ml)
as Eyeaze®0.1%: £4.15 (10ml)
0.2%: £4.15 (10ml)
0.4%: £4.15 (10ml)		3 month expiry.
as ClinOptic®0.1%: £4.15 (10ml)
0.21%: £4.15 (10ml)		6 month expiry.
Carmelloseas Optho-Lique®
0.5%: £3.73 (10ml)
28 day expiry.
as Optho-Lique Forte®1%: £2.83 (10ml)28 day expiry.
Preservative-free
as Eyeaze carmellose preservative-free®
0.5% drops: £2.87 (10ml)
1% drops: £1.81 (10ml)		3 month expiry.
as VIZcellose preservative-free®0.5% drops: £2.88 (10ml)
1% eye drops: £1.82 (10ml)		3 month expiry.
Polyvinyl alcoholas Sno Tears®1.4%: £1.06 (10ml)28 day expiry.
Preservative-free
as Refresh Ophthalmic®		1.4%: £2.25 (30 x 0.4ml)
Propylene GlycolPreservative-free
as Systane®		0.3%: £4.66 (28 x 0.8ml)
Preservative-free
as Systane Ultra®		0.3%: £6.69 (30 x 0.7ml)
Paraffin based ointmentPreservative-free
as Hydramed Night®		£2.32 (5g)3 month expiry.
Immunosuppressants, Calcineurin inhibitors and related drugs
Ciclosporin as Ikervis®0.1% eye drop 0.3ml unit dose: £72.00 (30)For treating dry eyes unresponsive to artificial tears as per traffic light guidance.