BNF for Children 2011-2012

BNFC 2011–2012 11.7 Local anaesthetics 529Indication and doseSee also notes aboveRaised intra-ocular pressure in ocular hypertensionand open-angle glaucomaChild 1 month–2 years 1 drop of 0.5% or 1%solution 3 times dailyChild 2–18 years 1 drop 4 times dailyPre-operatively in goniotomy and trabeculotomyChild 1 month–18 years apply 1% or 2% solutiononce dailyPilocarpine Hydrochloride (Non-proprietary) AEye drops, pilocarpine hydrochloride 1%, 10 mL =£3.00; 2%, 10 mL = £2.87; 4%, 10 mL = £3.83Excipients may include benzalkonium chlorideSingle useMinims c Pilocarpine Nitrate (Bausch & Lomb) AEye drops, pilocarpine nitrate 2%, net price 20 0.5 mL = £10.0411.7 Local anaestheticsOxybuprocaine and tetracaine are widely used topicallocal anaesthetics. Proxymetacaine causes less initialstinging and is particularly useful for children. Oxybuprocaineor a combined preparation of lidocaineand fluorescein is used for tonometry. Tetracaine producesmore profound anaesthesia and is suitable for usebefore minor surgical procedures, such as the removalof corneal sutures. It has a temporary disruptive effecton the corneal epithelium. Lidocaine, with or withoutadrenaline (epinephrine), is injected into the eyelids forminor surgery, while retrobulbar or peribulbar injectionsare used for surgery of the globe itself, see section 15.2,p. 649. Local anaesthetics should never be used for themanagement of ocular symptoms.Caution Local anaesthetic eye drops should beavoided in preterm neonates because of the immaturityof the metabolising enzyme system.LIDOCAINE HYDROCHLORIDE(Lignocaine hydrochloride)Contra-indications avoid in preterm neonatesIndication and doseLocal anaestheticUse as requiredMinims c Lidocaine and Fluorescein (Bausch & Lomb)AEye drops, lidocaine hydrochloride 4%, fluoresceinsodium 0.25%. Net price 20 0.5 mL = £10.61OXYBUPROCAINE HYDROCHLORIDE(Benoxinate hydrochloride)Contra-indications avoid in preterm neonatesIndication and doseLocal anaestheticUse as requiredMinims c Oxybuprocaine Hydrochloride (Bausch &Lomb) AEye drops, oxybuprocaine hydrochloride 0.4%. Netprice 20 0.5 mL = £8.92PROXYMETACAINEHYDROCHLORIDEContra-indications avoid in preterm neonatesIndication and doseLocal anaestheticUse as requiredMinims c Proxymetacaine (Bausch & Lomb) AEye drops, proxymetacaine hydrochloride 0.5%. Netprice 20 0.5 mL = £9.51With fluoresceinMinims c Proxymetacaine and Fluorescein (Bausch& Lomb) AEye drops, proxymetacaine hydrochloride 0.5%,fluorescein sodium 0.25%. Net price 20 0.5 mL =£10.59TETRACAINE HYDROCHLORIDE(Amethocaine hydrochloride)Contra-indications avoid in preterm neonatesIndication and doseLocal anaestheticUse as requiredMinims c Tetracaine Hydrochloride (Bausch & Lomb)AEye drops, tetracaine hydrochloride 0.5% and 1%.Net price 20 0.5 mL (both) = £8.9311.8 Miscellaneousophthalmic preparationsCertain eye drops, e.g. amphotericin, ceftazidime, cefuroxime,colistimethate sodium, desferrioxamine, dexamethasone,gentamicin, and vancomycin, can be preparedaseptically in a specialist manufacturing unit frommaterial supplied for injection.Preparations may also be available from Moorfields EyeHospital as manufactured specials, see also ‘specialorder’manufacturers or specialist importing companies,p. 809.11.8.1 Tear deficiency, ocularlubricants, andastringentsChronic soreness of the eyes associated with reduced orabnormal tear secretion often responds to tear replacementtherapy. The severity of the condition and thechild’s preference will often guide the choice of preparation.Hypromellose is the traditional choice of treatment fortear deficiency. It may need to be instilled frequently11 Eye