Acutely raised intraocular pressure with a hazy cornea, severe pain and abnormal pupil should be referred as an emergency as a potential acute angle closure glaucoma. The pupil is typically mid-dilated and non-reactive to light.
The pain with acute angle closure is typically severe and may be associated with nausea/vomiting. Analgesia may not improve the pain and reducing the pressure with IV acetazolamide +/- IV mannitol is effective.
It is also useful to note any family history of glaucoma in the referral and any new medications.
Raised intra-ocular pressure may also occur acutely in a few other situation e.g. uveitis due to herpes simplex virus or post-operatively. Patients with oil in situ following retinal detachment surgery can also have acutely raised intra-ocular pressure.
Who to refer:
Please see Lothian GP and optometry ophthalmology referral pathway.
Urgency of the condition for details on how soon patients should receive an appointment.
Please see condition specific information for descriptions and management of many common ophthalmological conditions.
Patients who present with a problem with their only seeing eye should be advised to see an optician/ophthalmologist for review.
Who not to refer:
How to refer:
We require a referral letter for EVERY patient.
The preferred referral process is via SCI Gateway. If sending/forwarding a referral via SCI gateway please include past medical history, allergies and medications
If you do not have access to fax or SCI Gateway e.g. if you have arranged an appointment out of hours please send a written referral letter with the patient to bring to their appointment.
Only if SCI Gateway is unavailable should a letter be typed or handwritten. Please write legibly and include your examination findings.
If you have arranged an appointment in the acute referral clinic and you are referring from within another hospital in Lothian please use TRAK to type the referral letter.
