Presentation of single and multiple- application ophthalmic preparations All ophthalmic preparations used in hospitals and nursing homes for direct application to the eye should be supplied in a sterile condition. Both single application and multiple application packs should have tamper-evident closures and packaging.

Formulation of eye-drops and eye ointments should comply with the criteria stated in the British and European Pharmacopoeias.

The working group endorses the principal of colour coding of eye-drop preparations, but feels that such an issue needs to be pursued at a European Union forum.

Labelling The small size of eye-drop and eye ointment containers may limit the amount of printed information with which a preparation is labelled.

At the time of dispensing, labelling of containers should specifically include: the words “for use in the eye only”; the name and concentration of the active ingredient(s); a statement to confirm the presence or absence of a preservative; directions for use; an “in-use” expiry date; any particular storage requirements; patient’s name; and date of dispensing.

Methods of use of eye-drops

(a) In the wards (inpatients) and nursing homes — All patients should receive a fresh supply of eye-drops on admission to hospital or nursing home. A separate bottle for each eye should only be supplied if both eyes require treatment and the patient has an open eye infection and/or medical opinion thus dictates. It is recommended that the period of use of each bottle should not exceed 14 days. This may include both inpatient and post-discharge use. (Br J Ophthalmol 1998;82:4735). A fresh supply of eye-drops should be provided after any eye surgery. If a fresh container of eye-drops is supplied on discharge from hospital this may be apportioned a “user life” of 28 days.

(b) In outpatient departments — Single application containers should be used whenever possible. Every patient who has undergone outpatient surgery and has evidence of current or recent ocular infection should be given a fresh supply of eye-drops after the operation, a separate bottle being supplied for each eye if both require treatment.

(c) In eye disease clinics, operating theatres and ophthalmic accident and emergency departments — These environments possess greater risk of transferring viral eye infections, notably epidemic keratoconjunctivitis and epidemic haemorrhagic conjunctivitis. There would appear to be a significant danger of transferring infection between patients in the handling of multiple-application eye-drop bottles. It is therefore essential that single application containers should be used whenever possible. Furthermore, every container, which is used, whether single application or multiple application, should be discarded after being used for each patient.

Extemporaneously prepared, preservative-free eye-drops It is recognised that these preparations are widely used in hospital practice and that although they should be discarded immediately after single use, in practice they are given an in-use life of one to seven days. This is an issue which requires urgent investigation.