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

Symptoms/signs of intermittent or acute angle-closure glaucoma

Intraocular pressure greater than 31mmHg

Urgent Care Services:

Royal Devon & Exeter Hospital: Attend ED

Previous records/information from other providers including:

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

Ocular Hypertension:

• Repeat intraocular pressure measurement as per OHT refinement scheme

Other conditions described above:

• Refer to secondary care

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 ICB-15N

Referral Forms

GP referral form

Opticians referral form

This guidance has been signed off by NHS Devon

Publication date: January 2017

Updated: January 2023