Use and supply of drugs

C 2.1.1 Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs). As such the supply of these drugs is controlled by law and optometrists (and OMPs), are the only members of the practice team who legally are responsible for the instillation of these POMs. The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

C 2.2.1 Registered Dispensing Opticians may order a limited list of POMs [see below] including these drugs for use in the practice.

• Amethocaine hydrochloride
• Chloramphenicol
• Cyclopentolate hydrochloride
• Fusidic acid
• Lignocaine hydrochloride
• Oxybuprocaine hydrochloride
• Proxymetacaine hydrochloride
• Tropicamide

C 2.3.1 Contact Lens Opticians (CLOs) may now instil a limited range of anaesthetics [see below] in the course of practice. The Association recommends that this should only be used by CLOs for complex contact lens fittings where it is needed to achieve a satisfactory result or by qualified Extended Services Contact Lens Opticians in the course of their duties.

• Lignocaine hydrochloride
• Oxybuprocaine hydrochloride
• Proxymetacaine hydrochloride

C2.3.2 Explicit and informed consent must be obtained and noted before administration of any topical preparations. Particular care should be taken in the case of pregnant or breastfeeding patients. Further information may be found here (from Dispensing Optics journal October 2019).

Chloramphenicol.

Registered dispensing opticians are able to supply chloramphenicol under the following circumstances.

C 2.4.1 In the case of acute bacterial conjunctivitis ONLY, the sale and supply of 0.5% Chloramphenicol drops [1% ointment] may now be instigated by all dispensing opticians. The restrictions of the pharmacy classification limit the supply to:

· a maximum pack size of 10ml [drops]/ 4gms [ointment]

· only in adults and children over 2 years of age

· for a maximum of 5 days. https://www.abdo.org.uk/regulation-and-policy/advice-and-guidelines/clinical/use-and-supply-of-drugs/

Earlier in 2021 we were made aware that some manufacturers had updated their product information to include a possible contraindication which would affect children under the age of two- (NOTE – this falls outside of the permissions on supply by dispensing opticians as detailed above). This contraindication stated that chloramphenicol drops must not be given to children under two years old due to it containing the excipient boron which may cause infertility. This contraindication did not apply to the ointment which does not contain boron

The Royal College of Ophthalmologists along with other professional bodies requested that the Medicines and Healthcare Regulatory Agency (MHRA) review the advice and in July 2021 the MHRA published new guidance linked below: https://www.gov.uk/drug-safety-update/chloramphenicol-eye-drops-containing-borax-or-boric-acid-buffers-use-in-children-younger-than-2-years

It is important to note:

1. Dispensing opticians can only supply chloramphenicol to children over two years of age and only in the case of acute bacterial conjunctivitis.

2. Parents presenting for advice and guidance for children under two should be directed to their GP.

References: 1. https://www.gov.uk/drug-safety-update/chloramphenicol-eye-drops-containing-borax-or-boric-acid-buffers-use-in-children-younger-than-2-years 2. https://www.rcophth.ac.uk/2021/04/safety-alert-boron-additives-in-chloramphenicol-drops/

C 2.4.2 See Dispensing Optics – Special Educational Supplement

C2.5.1 Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.

All drugs should be stored in accordance with manufactures instructions and must be kept out of reach of patients and visitors at all times. Drugs should be stored within a locked cupboard (or lockable fridge if required).

Lot numbers and expiry dates must be recorded on patients records for all drugs and diagnostic stains used in practice.

Quality in Optometry (QIO) GOS Contract (England) Section B contains useful statements to help support in the management and storage of drugs in practice.

Clinical and hazardous waste should be disposed of in accordance with current legislation.