CARDIFF REFERRAL GUIDELINES FOR ABNORMAL OCULAR CONDITIONS URGENT - SAME DAY SOON - PRIOR PRIOR TELEPHONE/ARRANGE IN TURN – BY LETTER OPTOMETRIST and / or GP TELEPHONE/Arrange appt appt- send patient WITH (priority assessed upon MANAGED Send patient WITH LETTER LETTER receipt) TEL: 029 2074 3191 TEL: 029 2074 3191 Chemical injuries Acute diplopia Cataracts Refractively managed squint Unexplained sudden loss of Herpes Zoster ophthalmicus Variable non-specific field defects vision (start anti-viral as appropriate (no other signs) ANTERIOR Penetrating injuries same day) Chronic blepharitis *GP* LIDS & AREA Hayfever and allergic ANTERIOR ANTERIOR Acquired ptosis conjunctivitis (mild with normal Dacryocystitis Rubeosis with V/A hand Basal cell carcinoma V/A) *GP* Hyphaema movements or better Changed melanosis of lids or Hordeolum Hypopyon Scleritis conjunctiva Ingrowing lashes (up to 3 Corneal ulcer with red eye Rust ring (GP removed corneal Entropion/Ectropion epilations performed) Periorbital inflammation with pain FB) Episcleritis (not clearing in 4 Meibomian gland dysfunction and swelling weeks) Pingueculae Pulsating proptosis VITREOUS Exophthalmos/Proptosis (good/ Sub-conjunctival haemorrhage Corneal foreign bodies (if Floaters with 3 months onset stable VA) *GP* OR OO unhappy to remove/suspect Vitritis Inflamed pingueculae Superficial foreign bodies *GP*or IOFB) Persistent blepharitis OO FUNDUS Persistent cysts of the glands of Disgnosed episcleritis *GP* Amaurosis fugax VITREOUS meibomian, zeis or moll Acute flashes and floaters with CORNEA Wet maculopathy – Amsler Persistent hordeolum tobacco dust Diagnosed corneal dystrophy Metamorphosia especially if sole Suspected malignant lesions Vitreous haemorrhage with good V/A eye and V/A 6/24 or better CONJUNCTIVA & AREA Chronic dry eye *GP* POSTERIOR ARMD with recent Amsler Conjunctival cysts or inclusions Pterygium not threatening visual CRAO within 24 hours, ideally 6 defects/symptoms of distortion giving rise to discomfort axis hours CRAO more than 24 hours old Conjunctivitis with abnormal V/A Superficial corneal abrasions Retinal breaks and tears CRVO (within 3 months) Persistent epiphora *GP* OR OO Retinal detachment Direct blunt trauma to eyeball Severe dry eye Suspected temporal arteritis VITREOUS Maculopathy with recent change Uveitis CORNEA Asteroid hyalosis in V/A Papilloedema/3rd nerve palsy – Keratoconus Optic disc pallor (suspected urgent to neurosurgery Pterygium threatening visual axis FUNDUS compressive lesion) Corneal dystrophy and reduced ‘Dry’ macular changes and stable Pre-retinal haemorrhage ACUTE GLAUCOMA V/A amsler with good VA Acute red eye with raised IOP Retinitis Follow-up hospital diagnosed flat (suspect angle closure) IRIS choroidal naevus can be GLAUCOMA Pupillary defects managed by O.O. IOP greater than 30 mmHg DIABETES Rubeosis with no sight (white eye, clear cornea, pain Vitreous haemorrhage in patient Suspected iris melanoma GLAUCOMA free) who has not had similar Incidental finding of unequal Cases with features such as IOP previously <26mmHg and normal discs that DIABETES pupils have been seen and discharged New vessels at disc or elsewhere VITREOUS by the HES and assessed Recurrent vitreous haemorrhage Floaters greater than 3 month stable/not glaucomatous and not in patient already under named onset with good vision changing consultant (patient will generally ring consultant’s secretary FUNDUS MACULAR DIABETES themselves) ARMD with no acute symptoms No significant changes *GP* of distortion (Consider referring all diabetics Macula hole to the Diabetic Screening Clinic) FUNDUS VASCULAR HEADACHES Hollenhurst plaques EYE CASUALTY AT UHW IS ON 029 2074 3191. RING Refer if orthoptic problem Retinal haemorrhages (non- BEFORE REFERRING Please only use in urgent cases otherwise to GP if no optometric diabetics) explanation ALL URGENT REFERRALS MUST BE ACCOMPANIED FUNDUS GENERAL BY A REFERRAL LETTER Optic disc pits Retinitis pigmentosa Suspected choroidal melanoma PLEASE NOTE: The ocular conditions listed in this Other unusual pigmented lesions document are intended to reflect those that might be Optic disc pallor (no obvious encountered in community practice and is not intended to cause) be exhaustive. The suggestions for referral have been devised for general GUIDANCE only. It does not remove GLAUCOMA from practitioners their professional responsibility to each Glaucoma suspect (with IOP patient, who should be dealt with on an individual basis. <30mmHg) based upon: Conditions marked *GP* may be managed by the patients’ . disc appearance, General Practitioner. field loss, . IOP greater than 5mm difference between eyes, DIABETES More than 5 haemorrhages, exudates or circinate lesions within the vascular arcade UNIVERSITY HOSPITAL OF WALES – EYE DEPARTMENT .