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
Dry eye symptoms can usually be managed satisfactorily with lubricant and lipid tear supplement eye drops and lifestyle changes.
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.
|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|11.8 Miscellaneous ophthalmic preparations|
|First line option for mild to moderate symptoms||Hypromellose |
|0.3% drops £1.05 (10ml)||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.|
as Evolve Hypromellose®
|0.3% drops: £1.98 (10ml)||Treatment for dry eyes associated with tear deficiency in patients who have sensitivity to benzalkonium chloride. Drops last 3 months from first opening. Suggest patients writes date of opening and expiry inside lid of box.|
|Second line options||Carbomer|
as Clinitas Carbomer gel®
|0.2% gel: £1.49 (10g)|
as Viscotears Single Dose®
|0.2% gel: £5.42 (30x0.6ml)|
as Blink Intensive Tears®
|0.2% drops: £2.97 (10ml)||28 day expiry.|
|Sodium Hyaluronate Preservative-free|
|10ml multi-dose eye drops:|
|0.5% drops: £3.73|
as VIZcellose preservative-free®
1% eye drops: £1.81 (10ml)
0.5% drops: £2.88 (10ml)
as Sno Tears®
|1.4% drops: £1.06 (10ml)|
|Polyvinyl alcohol Preservative-free|
as Refresh Ophthalmic®
|1.4% drops: £2.25 (30x0.4ml)|
|Propylene Glycol Preservative-free|
as Systane Ultra®
|0.3% P/F single use drops: £4.66 (28x0.8ml)|
0.3% P/F single use drops: £6.69 (30x0.7ml)
|Paraffin based ointment|
as Hydramed Night®
|ointment: £2.32 (5g)||Retinol palmitate 250iu/g, liquid paraffin, white soft paraffin, wool fat|
|In general preservative-free formulations are more expensive so limit to cases where:
- previously known sensitivity to eye drop preservatives such as benzalkonium chloride
- severe symptoms require eye drops to be applied more than six times a day after 4 weeks – there is increased risk of irritation from the preservatives as use increases
- if soft contact lenses worn
- or on the advice of a specialist
|For patients who find administration of eye drops difficult we recommend prescription of these devices
Opticare (for 2.5, 5, 10, 15 & 20ml bottles) £4.95
Opticare Arthro 5 (for 2.5 & 5ml bottles) £4.95
Opticare Arthro 10 (for 10, 15, 20ml bottles) £4.95
|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.|