Glaucoma

Scope

  • Ocular Hypertension
  • Open-Angle Glaucoma Suspect
  • Chronic Open-Angle Glaucoma
  • Acute Angle-Closure Glaucoma
  • Intermittent Angle-Closure Glaucoma
  • Chronic Angle-Closure Glaucoma

Assessment

Signs and Symptoms

Ocular Hypertension
  • No symptoms
  • Raised intraocular pressure
  • Normal optic disc and visual fields
Open-Angle Glaucoma Suspect
  • No symptoms
  • Optic disc appearance or pattern of visual field loss suggestive of possible glaucoma
  • Normal intraocular pressure
Chronic Open-Angle Glaucoma
  • No symptoms
  • Rarely blurred or 'patchy' vision
  • Glaucomatously damaged optic disc or glaucomatous pattern of visual field loss
  • Intraocular pressure raised or normal
  • Open drainage angle
Acute Angle-Closure Glaucoma
  • Severe ocular pain, haloes around lights, reduced vision
  • Conjunctival injection, dull corneal reflex, pupil enlarged and poorly reactive to light, raised intraocular pressure (typically more than 40mmHg)
Intermittent Angle-Closure Glaucoma
  • Intermittent blurred vision, ocular pain (mild or severe) +/- haloes around lights
  • Symptoms typically worse in dim light and alleviated by sleep
Chronic Angle-Closure Glaucoma
  • No symptoms
  • Rarely blurred or 'patchy' vision
  • Glaucomatously damaged optic disc or glaucomatous pattern of visual field loss
  • Narrow/closed drainage angle

History and Examination

GP
  • Previous medical history including medications/allergy list and family history
  • BMI
  • Mobility
  • Need for interpreter
Optometrist
  • Previous ocular history
  • Ocular family history
  • Anterior segment examination findings
  • Goldmann intraocular pressure
  • Drainage angle assessment (gonioscopy or van Herricks)
  • Optic disc assessment
  • Visual fields

Red Flags

Symptoms/signs of intermittent or acute angle-closure glaucoma

Intraocular pressure >31mmHg

Urgent Care Services:

Royal Devon & Exeter Hospital: Attend ED

Investigations

Previous records/information from other providers including:

  • letters
  • optic disc imaging
  • visual fields
  • ocular laser/surgery records

Management

Ocular Hypertension:
  • Repeat intraocular pressure measurement as per OHT refinement scheme
Other conditions described above:
  • Refer to secondary care

Referral

Referral Criteria

The referrer must confirm that the patient understands that the purpose of the referral is for assessment to determine appropriate management

Referrals must include a DRSS referral form or Opticians referral form and accompanying information from the GP inclusive of information detailed above

Referral Instructions

e-Referral Service Selection

  • Specialty: Ophthalmology
  • Clinic Type: Glaucoma
  • Service: DRSS-Eastern-Ophthalmology-Devon CCG- 15N

Referral Forms

DRSS (GP) Referral Form

Optician Referral Form

Supporting Information

This guidance has been signed off by NEW Devon CCG

Publication date: January 2017

 

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