NHS Policies: Eye lubricants

September 25, 2025

It was concerning to recently learn that some GP surgeries are refusing to prescribe eye drops for patients with facial paralysis, claiming they are ‘over-the-counter items’ that come under the heading of self-care. This is despite some affected patients being under the guidance of ophthalmology at their hospital.

The NHS England policy guidance here explains the ‘do not prescribe’ recommendations. These could be:

Items with limited evidence of clinical effectiveness, e.g. vitamins and probiotics under certain circumstances.
Self-limiting conditions, e.g. coughs, colds, conjunctivitis, infrequent cold sores of the lips, and more.
Minor conditions suitable for self-care.

Dry eye is listed under the ‘minor conditions suitable for self-care’ and the guidance is aimed at people with dry eye syndrome or sore tired eyes, with minor or moderate symptoms.

Having an incomplete blink should not be considered a moderate issue. If you think of a car windscreen, it needs screen wash in the washer bottle as well as working window wipers to ensure optimum visibility and therefore safety for the driver. If just one of these things isn’t present then an accident could occur. GP surgeries should not be using dry eye symptoms alone as a reason for not prescribing eye drops to a patient with an incomplete blink due to facial paralysis. When the blink mechanism is not there, like the faulty car window wiper, the lubrication does not spread properly across all parts of the eye.

What are the dangers of self-care in this patient group?

Some people with facial paralysis due to tumour removal, for example, have no feeling in their eye. Pain is not an indicator of needing to administer eye drops.
Patients using eye lubricants more than four times a day need preservative-free eye drops, as preservatives can damage the cornea if used too frequently.
Patients may not realise they need eye drops. The eye tends to over-water when it becomes too dry, patients often assume they do not have a dry eye problem when this happens.
A poorly managed eye due to facial paralysis can lead to patients needing surgeries to protect the eye if the cornea becomes damaged. This in the long run will be costlier to the NHS.
Eyesight can be permanently damaged with incorrect care.
Not all eye lubricants are the same and patients need guidance regarding which products to use.
Conjunctivitis is more painful in a non-blinking eye and takes longer to resolve in the paralysed eye. This comes under self-limiting conditions in the guidance.

Patients with an incomplete blink do learn self-care techniques out of necessity, because the condition is extremely painful. This is not a moderate condition and should not be treated as such.

Facial Palsy UK is requesting that the NHS improve the information available to this patient group and we are still campaigning for a Facial Palsy page on the NHS websites in England and Scotland. Whilst Bell’s palsy is described, there are more than 60 different causes of facial palsy and as is evident from the changes to prescribing practices, GPs and pharmacists still do not fully understand the condition and its risks and complications.

I was born with facial palsy and basically left to get on with it. I have never been able to blink or close my eye properly and with no guidance from my GP and no internet in the 1970s and 80s, my childhood was plagued by eye pain. As soon as I started earning money I purchased over-the-counter eye drops in a desperate bid to relieve the pain and also because I didn’t like the unsightly redness in my eye. There was no education and I chose the wrong type of eye drops which could damage my cornea. Finally in my late thirties I was referred to an ophthalmologist for the first time in my life and guided as to the best eye drops for my condition. It is frightening to think that the NHS may return to the last century’s ways of managing facial palsy. More education is desperately needed.

Karen Johnson, Co-CEO, Facial Palsy UK.

‘A GP suggesting an over the counter (OTC) prescription presents a danger to the patient in 2 ways. Firstly, the patient may interpret it as a ‘’nice to have’’ rather than an essential and potentially sight saving part of the management plan. Secondly, patients may not be able to afford the prescription cost and hence be unable to purchase, with similar devastating consequences. The fact that it is an essential part of sight preserving management should encourage the NHS to consider the use of eye drops and ointment in facial palsy as an exemption from the OTC rule.

Dr Simon Lowe, Facial Palsy UK Medical Advisory Board.