BNF for Children 2011-2012

532 11.8.2 Ocular diagnostic and peri-operative preparations BNFC 2011–201211 Eye11.8.2 Ocular diagnostic andperi-operativepreparationsOcular diagnostic preparationsFluorescein sodium is used in diagnostic proceduresand for locating damaged areas of the cornea due toinjury or disease.FLUORESCEIN SODIUMIndication and doseDetection of lesions and foreign bodiesSufficient to stain damaged areasMinims c Fluorescein Sodium (Bausch & Lomb)Eye drops, fluorescein sodium 1% or 2%. Net price 20 0.5 mL (both) = £7.53With local anaestheticSection 11.7Ocular peri-operative drugsDrugs used to prepare the eye for surgery and drugs thatare injected into the anterior chamber at the time ofsurgery are included here.Sodium hyaluronate is used during surgical procedureson the eye.Apraclonidine, an alpha 2 -adrenoceptor agonist,reduces intra-ocular pressure possibly by reducing theproduction of aqueous humour. It is used for short-termtreatment only.Balanced Salt Solution is used routinely in intra-ocularsurgery (section 11.8.1).ACETYLCHOLINE CHLORIDECautions gastro-intestinal spasm, peptic ulcer; heartfailure; asthma; hyperthyroidism; urinary-tractobstructionPregnancy avoid unless potential benefit outweighsrisk—no information availableBreast-feeding avoid unless potential benefit outweighsrisk—no information availableLicensed use not licensed for use in childrenIndication and doseCataract surgery, penetrating keratoplasty, iridectomy,other anterior segment surgeryrequiring rapid complete miosisConsult product literatureMiochol-E c (Novartis) AIntra-ocular irrigation, powder for reconstitution,acetylcholine chloride 10 mg/mL (1%) when reconstituted,net price 20-mg vial (with solvent) = £7.28Miphtel c (SD Healthcare) AIntra-ocular irrigation, powder for reconstitution,acetylcholine chloride 10 mg/mL (1%) when reconstituted,net price 20-mg vial (with solvent) = £7.28APRACLONIDINENote Apraclonidine is a derivative of clonidineCautions history of angina, severe coronary insufficiency,recent myocardial infarction, heart failure,cerebrovascular disease, vasovagal attack, chronicrenal failure; depression; pregnancy and breast-feeding;monitor intra-ocular pressure and visual fields;loss of effect may occur over time; suspend treatmentif reduction in vision occurs in end-stage glaucoma;monitor for excessive reduction in intra-ocular pressurefollowing peri-operative use; interactions:Appendix 1 (alpha 2 -adrenoceptor stimulants)Skilled tasks Drowsiness may affect performance of skilledtasks (e.g. driving)Contra-indications history of severe or unstable anduncontrolled cardiovascular diseaseSide-effects dry mouth, taste disturbance; hyperaemia,ocular pruritus, discomfort and lacrimation(withdraw if ocular intolerance including oedema oflids and conjunctiva); headache, asthenia, dry nose;lid retraction, conjunctival blanching and mydriasisreported after peri-operative use; since absorptionmay follow topical application systemic effects (seeClonidine, section 2.5.2) may occurLicensed use 0.5% drops not licensed for use inchildren under 12 years; 1% drops not licensed foruse in childrenIndication and doseSee preparations belowIopidine c (Alcon) AOphthalmic solution (= eye drops), apraclonidine 1%(as hydrochloride). Net price 12 2 single use 0.25-mL units = £77.81DoseControl or prevention of postoperative elevation ofintra-ocular pressure after anterior segment lasersurgeryApply 1 drop 1 hour before laser procedure then 1 dropimmediately after completion of procedureOphthalmic solution (= eye drops), apraclonidine0.5% (as hydrochloride). Net price 5 mL = £10.88Excipients include benzalkonium chlorideDoseShort-term adjunctive treatment of chronic glaucomain patients not adequately controlled by another drug(see note below)Child 12–18 years apply 1 drop 3 times daily usually formax. 1 monthNote May not provide additional benefit if patient alreadyusing two drugs that suppress the production of aqueoushumourDICLOFENAC SODIUMLicensed use not licensed for use in childrenIndication and doseInhibition of intra-operative miosis during cataractsurgery (but does not possess intrinsicmydriatic properties), postoperative inflammationin cataract surgery, strabismus surgery,argon laser trabeculoplastyconsult product literature