Serum eye drops (SED) are a useful adjunctive treatment for patients with severe ocular surface disease (OSD), especially those with a compromised tear film. Serum contains a large number of epitheliotrophic factors that are present in tears. These factors are likely to be responsible for the therapeutic benefits observed with SED therapy compared to conventional commercially available ocular lubricants. Prescribed and over-the-counter tear substitutes primarily alleviate symptoms through reduction of friction and shear-forces caused by blink-induced biomechanical trauma. This mechanism of action appears largely to be independent of structural chemistry and viscosity of the lubricant product. By contrast, SED provide a variety of nutritional molecules such as vitamins, glucose, growth factors, and immunoglobulins. These help to restore an environment that promotes reepithelialisation and supports ocular surface health.

SED are currently classified by the Medicines and Healthcare products Regulatory Agency (MHRA) as an unlicensed medicinal product (ie, hospital ‘special’). The MHRA advises that anyone prescribing an unlicensed product must be satisfied that there is a special need for the unlicensed medicinal product, and that the unlicensed medicine should not be supplied where an equivalent licensed medicinal product can meet the special needs of the patient. This college guideline sets out recommendations and good practice points for the safe use of SED for the treatment of severe OSD. It aims to improve not only compliance with MHRA advice, but also standardise practice and improve patient morbidity. The following areas have been addressed:

  • Patient groups that may benefit from the use of SED

  • Clinical situations for the use of autologous SED (Auto-SED) and allogeneic SED (Allo-SED)

  • SED formulation, frequency of therapy, and withdrawal

  • Monitoring of treatment efficacy

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