BNF for Children 2011-2012

BNFC 2011–2012 11.9 Contact lenses 533Voltarol c Ophtha Multidose (Novartis) AEye drops, diclofenac sodium 0.1%, net price 5 mL =£6.68Excipients include benzalkonium chloride, disodium edetate, propyleneglycolSingle useVoltarol c Ophtha (Novartis) AEye drops, diclofenac sodium 0.1%. Net price pack of5 single-dose units = £4.00, 40 single-dose units =£32.00FLURBIPROFEN SODIUMLicensed use not licensed for use in childrenIndication and doseInhibition of intra-operative miosis (but doesnot possess intrinsic mydriatic properties),control of postoperative and post-laser trabeculoplastyinflammation (if corticosteroidscontra-indicated)consult product literatureOcufen c (Allergan) AOphthalmic solution (= eye drops), flurbiprofensodium 0.03%, polyvinyl alcohol (Liquifilm c ) 1.4%.Net price 40 0.4 mL = £37.15KETOROLAC TROMETAMOLLicensed use not licensed for use in childrenIndication and doseProphylaxis and reduction of inflammation andassociated symptoms following ocular surgeryconsult product literaturetap water coming into contact with the lenses. Thecondition is especially associated with the use of softlenses (including frequently replaced lenses) and shouldbe treated by specialists.Contact lenses and drug treatment Special care isrequired in prescribing eye preparations for contact lensusers. Some drugs and preservatives in eye preparationscan accumulate in hydrogel lenses and can causeadverse reactions. Therefore, unless medically indicated,the lenses should be removed before instillationof the eye preparation, and not worn during the periodof treatment. Alternatively, unpreserved drops can beused. Eye drops may, however, be instilled whilepatients are wearing rigid corneal contact lenses. Ointmentpreparations should never be used in conjunctionwith contact lens wear; oily eye drops should also beavoided.Many drugs given systemically can also have adverseeffects on contact lens wear. These include oral contraceptives(particularly those with a higher oestrogencontent), drugs which reduce blink rate (e.g. anxiolytics,hypnotics, antihistamines, and muscle relaxants), drugswhich reduce lacrimation (e.g. antihistamines, antimuscarinics,phenothiazines and related drugs, somebeta-blockers, diuretics, and tricyclic antidepressants),and drugs which increase lacrimation (including ephedrineand hydralazine). Other drugs that can affectcontact lens wear are isotretinoin (can cause conjunctivalinflammation), aspirin (salicylic acid appears in tearsand can be absorbed by contact lenses—leading toirritation), and rifampicin and sulfasalazine (can discolourlenses).Acular c (Allergan) AEye drops, ketorolac trometamol 0.5%. Net price5 mL = £3.00Excipients include benzalkonium chloride, disodium edetate11.9 Contact lensesSome children and adolescents prefer to wear contactlenses rather than spectacles for both cosmetic andmedical reasons. Visual defects are corrected by eitherrigid (‘hard’ or gas permeable) lenses or soft (hydrogel)lenses; soft lenses are the most popular type, becausethey are initially the most comfortable, but they may notgive the best vision. Lenses should usually be worn for aspecified number of hours each day and removed forsleeping. The risk of infectious and non-infectious keratitisis increased with extended continuous contact lenswear in children, and it is not recommended exceptwhere medically indicated.Contact lenses require meticulous care. Poor compliancewith directions for use, and with daily cleaning anddisinfection, can result in complications including ulcerativekeratitis or conjunctivitis. One-day disposablelenses, which are worn only once and therefore requireno disinfection or cleaning, are becoming increasinglypopular.Acanthamoeba keratitis, a painful and sight-threateningcondition, is associated with ineffective lens cleaningand disinfection, the use of contaminated lens cases, or11 Eye