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 | | | |

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|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. | |

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| | |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 | | | |

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| |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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