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Glaucoma (chronic open angle glaucoma) – Adult

Glaucoma (chronic open angle glaucoma) – Adult

Emergency and immediate referrals

Referral to Emergency Department:

  • Nil

Immediate Referral (seen within 7 days):

  • Acute angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, ‘rainbows’ around lights, or sluggish pupil reactions)
  • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
  • Patients with intraocular pressure (IOP) >35mmHg
  • Patients with elevated IOP of 25-35 mmHg with accompanying signs (e.g. uveitic glaucoma)
  • Uveitic glaucoma, neovascular, lens related glaucoma, unstable secondary glaucoma

To contact the relevant service, please refer to HealthPathways Acute Ophthalmology Assessment (seen within 7 days).

Presenting symptoms
  • Suspected or known glaucoma
Mandatory referral information (referral will be returned if this information is not included)
  • Details and duration of treatments
  • Severity of symptoms
  • Family history
  • Most recent optometrist or private ophthalmologist report including:
    • Visual acuity
    • Refraction
    • Intraocular pressure (IOP)
    • Gonioscopy
    • Pachymetry
    • Visual fields
    • Disc assessment

If unable to attach reports, please include relevant information/results in the referral

Referrer to state reason if not able to include mandatory referral information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information

Other relevant optometrist or ophthalmologist reports/results such as:

  • Optical coherence tomography (OCT)
  • Retinal nerve fibre layer results
  • Optic disc photos
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days

Likely diagnosis of glaucoma and any of the following:

  • IOP 30-35 mmHg
  • severe disc damage
  • severe field loss 
Category 2
Appointment within 90 days

Likely diagnosis of glaucoma and any of the following:

  • signs of early disc damage or field loss consistent with glaucoma
  • IOP >28mmHg <30mmHg without disc damage or field loss
  • suspicion of narrow iridocorneal angles with risk of angle closure glaucoma 
Category 3
Appointment within 365 days

IOP ≥22mmHg < 28mmHg WITH any of the following:

  • central corneal thickness <555
  • high risk medicine (e.g. steroids)
  • history of trauma
  • pseudo exfoliation
  • pigment dispersion
  • very high myopia
  • family history 
Excluded ophthalmology services

Referral to public ophthalmology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Stable, mild glaucoma
Useful Information for referring practitioners
wa.gov.au