BNF for Children 2011-2012

BNFC 2011–2012 11.3.3 Antivirals 521Many different fungi are capable of producing ocularinfection; they can be identified by appropriate laboratoryprocedures.Antifungal preparations for the eye are not generallyavailable. Treatment is normally carried out at specialistcentres, but requests for information about supplies ofpreparations not available commercially should beaddressed to the Strategic Health Authority (or equivalentin Scotland or Northern Ireland), or to the nearesthospital ophthalmology unit, or to Moorfields Eye Hospital,162 City Road, London EC1V 2PD (tel. (020) 72533411) or www.moorfields.nhs.uk11.3.3 AntiviralsHerpes simplex infections producing, for example,dendritic corneal ulcers can be treated with aciclovir.Aciclovir eye ointment is used in combination withsystemic treatment for ophthalmic zoster (section5.3.2.1).For systemic treatment of CMV retinitis, see section5.3.2.2.Topical corticosteroids should normally only be usedunder expert supervision; three main dangers are associatedwith their use:. a ‘red eye’, when the diagnosis is unconfirmed, maybe due to herpes simplex virus, and a corticosteroidmay aggravate the condition, leading to cornealulceration, with possible damage to vision andeven loss of the eye. Bacterial, fungal, and amoebicinfections pose a similar hazard;. ‘steroid glaucoma’ may follow the use of corticosteroideye preparations in susceptible individuals;. a ‘steroid cataract’ may follow prolonged use.Other side-effects of ocular corticosteroids include thinningof the cornea and sclera. Prolonged use in neonatesand infants can cause adrenal suppression.Products combining a corticosteroid with an antimicrobialare used after ocular surgery to reduce inflammationand prevent infection: use of combination productsis otherwise rarely justified.Systemic corticosteroids (section 6.3.2) may be usefulfor ocular conditions. The risk of producing a ‘steroidcataract’ increases with the dose and duration ofcorticosteroid use.ACICLOVIR(Acyclovir)Side-effects local irritation and inflammation, superficialpunctate keratopathy; rarely blepharitis; veryrarely hypersensitivity reactions including angioedemaIndication and doseLocal treatment of herpes simplex infectionsApply 5 times daily (continue for at least 3 daysafter complete healing)Herpes simplex skin infections section 13.10.3Herpes simplex and varicella–zoster infectionssection 5.3.2.1Zovirax c (GSK) AEye ointment, aciclovir 3%. Net price 4.5 g = £9.3411.4 Corticosteroids and otheranti-inflammatorypreparations11.4.1 Corticosteroids11.4.2 Other anti-inflammatory preparations11.4.1 CorticosteroidsCorticosteroids administered locally to the eye or givenby mouth are effective for treating anterior segmentinflammation in uveitis (section 11.5) and followingsurgery.BETAMETHASONECautions see notes aboveSide-effects see notes aboveIndication and doseLocal treatment of inflammation (short-term)Apply eye drops every 1–2 hours until controlledthen reduce frequency; eye ointment 2–4 timesdaily or at night when used with eye dropsBetnesol c (UCB Pharma) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%. Net price 10 mL = £2.23Excipients include benzalkonium chloride, disodium edetateEye ointment, betamethasone sodium phosphate0.1%. Net price 3 g = £1.36Vistamethasone c (Martindale) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%. Net price 5 mL = £1.02; 10 mL =£1.16Excipients include benzalkonium chlorideWith neomycinBetnesol-N c (UCB Pharma) AUDrops (for ear, eye, or nose), see section 12.1.1DEXAMETHASONECautions see notes aboveSide-effects see notes aboveIndication and doseLocal treatment of inflammation (short-term)Apply eye drops 4–6 times daily; severe conditionsevery 30–60 minutes until controlled then reducefrequencyMaxidex c (Alcon) AEye drops, dexamethasone 0.1%, hypromellose 0.5%.Net price 5 mL = £1.42; 10 mL = £2.80Excipients include benzalkonium chloride, disodium edetate, polysorbate8011 Eye