At treatment day 30, the mean decrease in osmolarity 5 minutes postapplication was significantly greater with Blink Tears compared to Systane and Refresh

Eye drops - allnon-formulary GREY, no formal assessment.See Eye lubricant guidelinesand Eye lubricants table of productsfor alternatives. A third study analyzing Refresh and Systane products compared the effects of Refresh Liquigel ® and Systane ® on corneal staining and symptomatic improvement in 60 patients. 30 A reduced sum score of corneal staining and a reduction of corneal staining from baseline were only observed in the Refresh Liquigel ® group ( P=0.008 and P=0.019, respectively). Patient’s tear preference and comfort were also analyzed in this study; however, patients were not blinded to the artificial tear assigned. Using one eye for each artificial tear, patient preference was recorded 5 minutes after application with 36% of patients preferring Refresh and 24% preferring Systane. Limited value may be drawn from the subjective component of this study since unilateral symptoms may have been present in the study participants.Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation. Ans : In most of the cases, the average time taken by this medication to reach its peak effect is around 1 day to 1 week. Please consult your doctor for the time period you need to use this medication.

Optive 0.5% Eye Drops may cause side effects such as eye pain, irritation, and vision disturbances. These symptoms usually subside on their own. However, consult your doctor if these symptoms stay for a long time or if they become severe. Avoid driving or operating machines if you experience these symptoms. If patient becomes intolerant to this VisuXL ® eye gel (CMC formulation), the VisuXL ® eye drop formulation may be tried instead. Optive Plus ®(carboxymethylcellulose 0.5%, glycerine 1%, castor oil 0.25%) is also non-formulary - see above. The equivalent formulary product containing mineral oil is Systane Balance. SFH advice only: Each dose unit contains 8 drops and can be re-capped and used within 24 hours of opening.Questionnaire revealed 68.9% of Hylo-Comod users and 78.5% of Systane users had improvement of symptoms by switching to Refresh Optive. TBUT also improved with Refresh Another randomized controlled study analyzing lipid-based tear substitutes looked at their effect on TBUT, Schirmer’s test, tear meniscus, and subjective symptoms. 49 This crossover study compared Tears Again ® (OcuSoft, Rosenberg, TX, USA) to Liposic ® (Bausch & Lomb) in 74 patients with a history of dry eye over two separate 6-week periods. In both the initial treatment and after cross-over, Tears Again ® improved all the aforementioned subjective and objective endpoints ( P<0.05); 62.5% of patients preferred Tears Again ®, 25% preferred Liposic ®, and 12.5% found the preparations to be equal. Corneal staining reduced greater from baseline with Refresh Liquigel than Refresh Tears, but more adverse events occurred with the Liquigel

Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting. Optive Fusion ® - Hyaluronate 0.1%, carmellose 0.5%, glycerol 0.9% (preserved and preservative free) To be used in patients where sodium hyaluronate alone no longerprovides adequate control in moderate to severe dry eye, in accordance with the Dry Eye Treatment guidance. Brand names: Advanced Eye Relief Dry Eye, Alcon Tears, Artelac Nighttime, Artificial Tears, Bion Tears, Optive Eye Drop is usually taken when needed. Use the number of drops as advised by your doctor. Wait for at least 5-10 minutes before delivering any other medication in the same eye to avoid dilution. Do not use a bottle if the seal is broken before you open it. Always wash your hands and do not touch the end of the dropper. This could infect your eye. This medicine may require long-term use and can be taken safely for as long as you need it.

4. How and when to use carmellose sodium

Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC. The 0.4% unit dose vials are restricted to those using artificial tears >4 times per day and who struggle to use the COMOD eyebottle device