Moorfields Eye Hospital NHS Foundation Trust

4. Miss Y complains the Trust incorrectly prescribed her olopatadine (eye drops used to treat itching) between April 2022 and July 2023.

5. Miss Y says the medication contains preservatives which she says she is allergic to, and it caused side effects such as pain and a burning sensation in her eyes. She says the medications caused side effects which still continue and are not related to the eyes. Miss Y now has difficulty sleeping as she is in unbearable pain every night, she also says her vision has deteriorated as a result of this medication.

6. Miss Y would like to achieve a financial payment.

7. Miss Y is in her mid-sixties and has been previously diagnosed with dry eyes, recurrent epithelial erosions (loss of eye tissue), epithelial basement membrane dystrophy (abnormal membrane growth in the eye), allergic eye disease, and corneal scarring from herpes simplex (a common lifelong virus).

8. The Trust prescribed Miss Y with olopatadine for four months due to her allergic eye disease on 14 June 2019.

9. It prescribed this again on 5 March 2020 and 24 June 2022.

10. On 22 June 2022 Miss Y attended A&E due to pain in both her eyes.

11. On 31 July 2023, she had a telephone consultation with the Trust in which she was informed of the preservatives in the eye drops. It was at this point, Miss Y stopped taking the eye drops.

12. Miss Y attended A&E on 1 August 2023 due to the pain she was suffering from. It is at this point, the Trust become aware of her allergy to preservatives.

17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications something has gone wrong.

18. Miss Y has raised concerns the Trust prescribed her with the eye drops, olopatadine, which she was allergic to.

19. We are sorry to learn Miss Y feels she was prescribed the incorrect eye drops which caused her to have an allergic reaction. We understand how worrying and stressful was for Miss Y especially as she had to attend A&E several times due to her symptoms.

20. The Trust says, ‘Olopatadine is an anti-allergy eye drop which was prescribed for your itchy eyes. It is a commonly used eye drop but does contain preservatives. There is no mention in your notes of intolerance to preservatives, but this has now been added and we are sorry this was not previously noted.’

21. Miss Y’s notes show the Trust first prescribed olopatadine to her on 14 June 2019. It prescribed this for four months, to be taken twice a day in both eyes. This was due to her allergic eye disease, which is also known as allergic conjunctivitis and occurs when allergens cause inflammation of the eye.

22. This prescription is in line with the NICE guidance which says olopatadine can be prescribed for allergic conjunctivitis and should be, ‘apply twice daily; maximum duration of treatment 4 months’.

23. The Trust prescribed Miss Y olopatadine again in March 2020 and June 2022. This was prescribed for the appropriate duration and dose in line with the NICE guidance on both occasions.

24. Miss Y’s records show at clinical reviews on 5 March 2020 and 24 June 2022, the Trust has ticked to say Miss Y does not have any allergies.

25. The GMC guidance says, ‘Together with the patient, you should assess their condition before deciding to propose, prescribe or provide a medicine, treatment or device. You must have or take an adequate history, which includes:

a. any previous adverse reactions to medicines.’

26. We understand from our communications with Miss Y, she believes the Trust was aware of her allergy as she had been attending consultations with the Trust for some time. We have seen no medical records to show this allergy has been discussed or recorded. This is not to say Miss Y did not inform the Trust of her allergy, but we cannot see it has been documented within her medical records.

27. When we make decisions on complaints we need to rely on evidence. We were not present at the time of Miss Y’s clinical reviews and there are no independent witnesses of what was discussed. We consider on the balance of probabilities as the box has been ticked to say Miss Y does not have any allergies during more than one of these appointments, there was likely either some discussion or question about allergies, or Miss Y did not disclose her allergy during these clinical reviews.

28. This is in line with the medical practice guidance which says, ‘You must make sure that formal records of your work (including patients’ records) are clear, accurate, contemporaneous and legible.’

29. Overall, we consider the Trust has acted in line with this guidance by likely asking or giving Miss Y the opportunity to disclose any allergies prior to processing the prescription.

30. Miss Y’s medical records show she attended A&E on 1 August 2023. During this attendance Miss Y told the Trust of her allergy and it recorded this.

31. It is also documented during this attendance that Miss Y stopped taking olopatadine the day before, on 31 July 2023. This was following a telephone consultation in which she was informed the eye drops contained preservatives which she was allergic too. When Miss Y told the Trust of her allergy to the preservative during this telephone consultation, it informed her to stop taking the eye drops.

32. This is in line with the GMC guidance, which says, ‘promptly provide (or arrange) suitable advice, investigation or treatment where necessary’.

33. However, it is unclear from Miss Y’s medical records when she was prescribed olopatadine in 2023 as there are no appointments, reviews or attendances in 2023. Miss Y has said following the prescription in June 2022 she was given multiple doses which she took whenever she needed it.

34. Following, Miss Y informing the Trust of her allergy on 31 July 2023 and 1 August 2023 we can see the Trust updated her medical records to include this allergy. This is in line with the GMC guidance, which says records should be kept clearly, accurately and legibly.

35. We understand Miss Y went to A&E at the Trust on 24 June 2022. She presented with intermittent sharp pain in both eyes.

36. The NICE guidance lists olopatadine’s potential adverse reactions as, ‘local irritation. Less commonly keratitis, dry eye, local oedema, photophobia, headache, asthenia, dysgeusia, fatigue, dizziness, and dry nose’.

37. Our adviser noted Miss Y suffers from several diagnoses including dry eyes, recurrent epithelial erosions, epithelial basement membrane dystrophy, allergic eye disease, and corneal scarring from herpes simplex. Given these conditions, we would never be able to say the intermittent pain she was experiencing during this A&E visit was due to her allergy and not due to any of her other eye conditions.

38. Overall, there is no evidence Miss Y told the Trust of a potential allergy to preservatives during any of her clinical reviews and there is also no evidence the Trust should have considered a potential allergic reaction following Miss Y’s admittance’s to A&E.

39. We consider there is no indication of a failing here. We recognise this will not be the decision Miss Y is expecting, we hope our consideration allows her further understand and take some reassurance about the actions taken by the Trust and why it prescribed her with the eye drops. We hope she is also reassured that as soon as the Trust did find out there was an allergy to the preservative in the eye drop it has documented this and has not prescribed these eye drops to her again.

40. We wish her well with her ongoing eye health.

1. We have carefully considered Miss Y’s complaint about Moorfields Eye Hospital NHS Foundation Trust (the Trust). We have seen no indication anything went seriously wrong.

2. We understand Miss Y has raised concerns about the Trust incorrectly prescribing her with olopatadine. We consider the Trust acted in line with guidance by prescribing the olopatadine and was not aware of any allergies Miss Y had until 1 August 2023, which is when the eye drops were stopped. We do not consider there is any indication of a failing here.

3. We are sorry to learn Miss Y is in fear every night due to the pain in her eyes. We understand our decision will be disappointing to her. We hope our consideration of her complaint offers her some reassurance about the Trust’s care and actions.