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.

 

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Dry eyes: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.
Preservative free formulations are available for people who have sensitivity to benzalkonium chloride.
Suggest recording date of opening and expiry inside lid of box.
First line option for mild to moderate symptoms Hypromellose
as AaproMel®
as AacuLose®
as Lumecare tear®
0.3% drops £0.69 (10ml)
0.3% drops £0.71 (10ml)
0.3% drops £0.80 (10ml)


Hypromellose Preservative-free
as Evolve Hypromellose®
0.3% drops: £1.98 (10ml)
3 month expiry.
Second line optionsCarbomer
as AaCarb®
as Clinitas Carbomer gel®
0.2% gel: £1.39 (10g)
0.2% gel: £1.49 (10g)
28 day expiry.
Carbomer Preservative-free
as Evolve Carbomer 980®
as Ocu-Lube Carbomer 0.2% Eye Gel
0.2% gel: £2.70 (10g)

0.2% gel: £5.25 (30 x 0.6ml)
3 month expiry.

Sodium Hyaluronate
as Blink Intensive Tears®

0.2% drops: £2.97 (10ml)

28 day expiry.
Sodium Hyaluronate Preservative-free
as Blink Intensive Tears®

as Eyeaze®


as ClinOptic®


0.2% drops: £2.97 (20 x 0.4ml)

0.1%: £4.15 (10ml)
0.2%: £4.15 (10ml)
0.4%: £4.15 (10ml)
0.1%: £4.15 (10ml)
0.21%: £4.15 (10ml)




3 month expiry.


6 month expiry.
Carmellose
as Optho-Lique®
as Optho-Lique Forte®
0.5%: £3.73 (10ml)
1%: £2.83 (10ml)
28 day expiry.
Carmellose Preservative-free
as Eyeaze carmellose preservative-free®
as VIZcellose preservative-free®


0.5% drops: £2.87 (10ml)
1% drops: £1.81 (10ml)
0.5% drops: £2.88 (10ml)
1% eye drops: £1.82 (10ml)



3 month expiry.

3 month expiry.
Polyvinyl alcohol
as Sno Tears®
1.4%: £1.06 (10ml)28 day expiry.
Polyvinyl alcohol Preservative-free
as Refresh Ophthalmic®
1.4%: £2.25 (30 x 0.4ml)
Propylene Glycol Preservative-free
as Systane®

as Systane Ultra®
0.3%: £4.66 (28 x 0.8ml)

0.3%: £6.69 (30 x 0.7ml)
Paraffin based ointment
Preservative-free


as Hydramed Night®
£2.32 (5g)3 month expiry.
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.