Signs & Symptoms

• Blurred vision
• Reduced vision
• Glare
• Reduced colour sensitivity
• Monocular diplopia
• Marked discomfort

History and Examination

• Previous medical history including medications/allergy list & family history
• General Ophthalmic Services (GOS)
• Serial eye test results – when available – especially in Keratoconus
• Body Mass Index (BMI)
• Mobility
• Interpreter required

• Corneal abrasions / erosions
• Corneal ulcer
• Bacterial / viral – herpes/shingles
• Acute chemical injury

Urgent Care Services:

North Devon District Hospital: Attend ED

• GOS
• Previous records/information from other providers including:
  • letters,
  • laser surgery records, and
  • investigations (such as topography)

Keratoconus

• Management: Community optometrist management is not recommended as treatment (collagen cross linking) to prevent progression is available
• When to refer: Routine referral to Cornea service for corneal topography to confirm diagnosis and agree further management. Late community optometrist management may then be possible

Corneal dystrophies – Symptomatic (FUCHS')

• Management: mild cases can be managed by community optometrist if confident of the diagnosis until the patient is symptomatic
• When to refer: reduced vision – below driving standard

Pterygium

• Management: lubrication to control irritation
• When to refer: Routine referral if significant growth across limbus and severe symptoms warranting surgery

Recurrent corneal erosions

• Management: topical lubrication is usually helpful
• When to refer: when symptoms are not controlled by lubrication

Severe dry eye syndrome – including graft vs hose disease

• Management: not suitable for primary care management, however preservative free lubrication may be commenced until secondary care appointment has materialised
• When to refer: refer to secondary care

Suspected neoplasms of ocular surface - not the lids

• Management: not suitable for primary care management
• When to refer: refer to secondary care – 2 weeks pathway if suspected

Contact lens related problem

• Management: stop contact lens wear and send separately as well as the contact lens cases for culture and sensitivity and request analysis for bacteria and acanthamoeba if infection is suspeced
• When to refer: refer to secondary care – urgent care if suspected infection

Anterior segment complications from previous ocular/cataract surgery and other 2nd opinion

• Management: not suitable for primary care management
• When to refer: refer to secondary care

Previous chemical injuries needing further assessment

• Management: not suitable for primary care management
• When to refer: refer to secondary care

Referral Criteria

Before a referral is made the referrer must confirm that:

• The patient understands that the purpose of the referral is for assessment to determine appropriate management.

Referrals must include the following history and examination:

• GOS
• Previous medical history including medications/allergy list & family history
• Serial eye test results – when available – especially in Keratoconus
• BMI
• Mobility
• Interpreter required

Referral Instructions

e-Referral Service Selection

• Specialty: Ophthalmology
• Clinic Type: Cornea
• Service: DRSS-Northern-Ophthalmology- Devon ICB-15N

Referral Forms

GP referral form

Opticians referral form

Patient information

Patient information from the Royal College of Ophthalmologists

Pathway Group

This guidance has been signed off by NHS Devon

Publication date: January 2017

Updated: January 2023