Southland Hospital Ophthalmology Referral Criteria 1 Dec 2010
North Hampshire Ophthalmology Referral Criteria 1 August 2011 | |
|Page 1 |Condition |Recommendation |Referral to Ophthalmology |
|Referrals must contain corrected visual acuities with and without a pinhole for both eyes |
| |Red eye |Objectively decreased vision, severe |Phone department for acute same day referral |
| |suggestive of |pain or photophobia, pupil abnormalities, | |
| |serious |corneal staining (see also dendritic ulcer) | |
| |pathology | | |
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|Urgent | | | |
|Referrals | | | |
| | | | |
|Phone 313127 during | | | |
|office hours; FPH | | | |
|01276 604604 evenings| | | |
|and W/E | | | |
| |Sudden loss of |Recent marked loss of vision or symptoms suggestive of |Phone department for acute same day referral. Refer |
| |vision |important pathology, i.e. visual field defect, floaters, |amaurosis fugax to stroke clinic. |
| | |central scotoma or distortion. Check temporal arteries in| |
| | |elderly. | |
| | |Transient field loss with fortifications is migranous even| |
| | |without headache | |
| |Bacterial corneal |Red eye, pain photophobia, non- limbal or corneal |Phone department for acute same day referral |
| |ulcer |infiltrate with Fluorescein staining. | |
| | | | |
| | |Any child with red eye, in pain and | |
| | |obvious corneal ulceration, opacity or | |
| | |very poor red reflex | |
| |Orbital cellulitis |Must have one or more: Proptosis, diplopia, limited ocular|Phone department for acute same day referral. Refer |
| | |motility, decreased vision, fever or systemically unwell |children to paeds. |
| | |with lid swelling | |
| |Trauma |Any suggestion of penetrating injury |Phone department for acute same day referral |
| | |Lid margin laceration | |
| | |Chemicals (particularly alkalis) in eye, wash out first | |
| | |Blunt trauma – severe or small projected object with | |
| | |decreased vision or obvious hyphaema | |
| |Flashes and |Refer sudden onset of new floaters, |Do not refer chronic floaters |
| |floaters |daytime flashes with blurred vision | |
| |Dendritic ulcer |Any patient with red eye or blurred vision requires |Fax referral. Initiate treatment with Zovirax |
| | |corneal staining with Fluorescein and examination with |ointment 5 x daily |
| | |cobalt blue light | |
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|Semi urgent referral | | | |
|to ophthalmology | | | |
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|Label urgent | | | |
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|Fax 313264 | | | |
| |Herpes Zoster |Treat with Aciclovir 800 mg 5 times a |Does not need Ophthalmic work-up if eye not involved. |
| |Ophthalmicus |day for 1 week |Refer if reduced VA or red and painful eye at 10days post|
| | | |rash onset. |
| |Dacryocystitis |Acute swelling, erythaema and pain in |Start oral antibiotics to cover staph |
| | |medial canthus area | |
| |Wet macular |New central distortion or significant decrease in vision, |Consider direct referral to macular clinic at FPH. (We |
| |degeneration |presence of sub retinal fluid or haemorrhage (please |hope to start a macular service in Basingstoke after |
| | |supply photo if possible) |amalgamation with WEHCT) |
| |Potentially | |Refer with photo if available | |
| |malignant lid | |SCC/ MM: TWR | |
| |lesions | |BCC soon | |
| |Acquired cranial |Recent onset diplopia or strabismus. |Check ESR and CRP in elderly |
| |nerve palsy | | |
| |Diabetic patients |Recent change or obvious pathology on |Refer to ophthalmology |
| |with decreased |examination ( no red reflex, macular | |
| |vision or floaters |haemorrhages and hard exudates) | |
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|North Hampshire Ophthalmology Referral Criteria 1 August 2011 |
|Page 2 |Condition |Recommendation |Referral to Ophthalmology |
|Referrals must contain corrected visual acuities with and without a pinhole for both eyes |
| |Pterygium |Optometrist for |Refer to ophthalmology when |
| | |• Proof of distortion of mires and ongoing referral|• Proof of distortion of mires/irregular |
| | |if necessary |astigmatism or |
| | |• Photography of corneal involvement |• Photography confirms progressive corneal |
| | |to show progression |growth |
|Routine referrals | | | |
| | | | |
| |Strabismus |Orthoptic screening should assess children with no clear |Confirmed strabismus: refer to ophthalmology + |
| | |strabismus, reading difficulties |orthoptist |
| | |and seemingly normal vision | |
| |Diabetes |Background retinopathy to screening |Refer maculopathy/ preproliferative |
| | | |Urgent FAX proliferative |
| |Glaucoma |Refer if IOP: |Will require optometric assessment. Please forward |
| | |>21 and patient under 65 |report. |
| | |>24 and patient under 80 | |
| | |>25 and patient over 80 | |
| | |Progressive or pathological disc cupping | |
| | |Visual field defect | |
| | |Narrow angles | |
| |Entropion/ ectropion |Use ocular lubrication if uncomfortable |Refer to minor operating clinic | |
| |Chalazion or |GP to advise warm compresses and massage. Progressive |Refer if longstanding non-resolving |
| |Meibomian cysts |enlargement over 2/12 may indicate malignancy |chalazion > 6/12 and affecting vision |
|Patients currently | | | |
|do not | | | |
|meet the criteria | | | |
|for | | | |
|PCT funded | | | |
|Ophthalmology until | | | |
|specified thresholds| | | |
|are | | | |
|met | | | |
| | | | |
| |Isolated ptosis and |Do not refer unless lid obscures vision |Refer ptosis to oculoplastic clinic (if visual field |
| |dermatochalasis | |affected) |
| |Cataract |• Optometrist (preferable) or GP to monitor until |Do not refer adults until binocular acuity ................
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