Glaucoma (chronic open angle glaucoma)

Glaucoma (chronic open angle glaucoma) – Adult

Emergency and immediate referrals

Referral to Emergency Department:

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

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 in referral Note: This information is required to triage accurately, within a clinically suitable timeframe

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 in referral

Note: This information is required to triage accurately, within a clinically suitable timeframe

Highly desirable referral information
Other relevant optometrist or ophthalmologist reports/results if available and where providing it will not delay care: Optical coherence tomography (OCT) Retinal nerve fibre layer results Optic disc photos

Highly desirable referral information

Other relevant optometrist or ophthalmologist reports/results if available and where providing it will not delay care:

Indicative triage category

Indicative triage category
Cat 1 Appointment within 30 days	Likely diagnosis of glaucoma and any of the following: IOP 30-35 mmHg severe disc damage severe field loss
Cat 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
Cat 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

Cat 1
Appointment within 30 days

Likely diagnosis of glaucoma and any of the following:

Cat 2
Appointment within 90 days

Likely diagnosis of glaucoma and any of the following:

Cat 3
Appointment within 365 days

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

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

Please refer to the following HealthPathways: Open Angle Glaucoma
For optometry requests, please refer to the following HealthPathways: Optometry Requests

More information