Ophthalmology Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • The Ophthalmology Referral Guidelines which:
    • Identify Ocular conditions that may be encountered within primary care, with suggested referral options.
    • Are relevant to all age groups.
    • Use a traffic light approach to indicate the urgency of referral, where referral is indicated
  • MEC Symptom Based Referral Guidance
    • Minor Eye Conditions (MEC) Symptom Based Referral Guidance for patients presenting with an eye condition

This guidance does not cover:

  • All ocular conditions that may be encountered in primary care

Commissioning Statement:

Assessment

Signs and Symptoms

  • For clinical advice about specific conditions please click here to open the The Ophthalmology Referral Guidelines which are separated into anatomical sections moving from the anterior eye to the retina with an additional section on orthoptics. Against each of the following conditions there is a brief description of the typical signs and symptoms, an indication of the degree of urgency (using a traffic light colour), and some additional diagnostic and referral information
  • The Anterior Segment
    • Abnormal Iris Pigmentation
    • Acute Dacryocystitis
    • Allergic Conjunctivitis
    • Bacterial Corneal Ulcer
    • Bacterial
    • Conjunctivitis
    • Basal Cell Carcinoma
    • Blepharitis
    • BlepharitisUnresolved
    • Blepharospasm
    • Chalazion
    • Corneal Dystrophy
    • Dermatochalasis
    • Ectropion
    • Entropion
    • Episcleritis
    • Giant Papillary Conjunctivitis
    • Herpes Simplex Keratitis
    • Herpes Zoster Ophthalmicus
    • Hyphaema
    • Iritis
    • Iridoschisis
    • Keratoacanthoma
    • Keratoconus
    • Marginal Corneal Ulcer
    • Pinguecula
    • Poor Lacrimal Patency
    • Pterygium
    • Ptosis
    • Scleritis
    • Squamous Cell Carcinoma
    • Trauma to anterior segment
    • Trichiasis
    • Viral Conjunctivitis
  • The Lens
    • Congenital Cataract
    • Ectopia Lentis
    • Post Cataract Complications
    • Posterior Capsular Thickening
    • Pseudo-exfoliation
  • The Vitreous
    • Asteroid Hyalosis
    • PVD Uncomplicated
    • PVD Complicated
    • Synchysis Scintillans
    • Vitreous Haemorrhage
  • The Optic Disc
    • Hypoplastic Disc
    • Morning Glory Syndrome
    • Myelinated Nerve Fibres
    • Optic Disc Coloboma
    • Optic Disc
    • Drusen
    • Optic Disc Haemorrhage
    • Optic Disc Pit
    • Optic Neuritis
    • Swollen Disc
    • Tilted Disc
  • The Retina
    • Best Disease
    • Bulls Eye Maculopathy
    • Branch Retinal Artery Occlusion
    • Branch Retinal Vein Occlusion
    • Central Retinal Artery Occulsion
    • Central Retinal Vein Occlusion
    • Central Serous Retinopathy
    • CHRPE -(Congenital hypertrophy of Retinal Pigment Epithelium)
    • Choroidal Nevus
    • Cystoid Macula Oedema
    • Diabetic Retinopathy
    • Diabetic Macular Oedema
    • Epiretinal Membrane
    • Lattice Degeneration
    • Macular Hole
    • Retinal Detachment
    • Retinal Haemorrhages
    • Retinoschisis
    • Retinitis Pigmentosa
    • Tamoxifen Retinopathy
    • Toxoplasmosis
  • Orthoptics
    • Esotropia - Constant intermittent or accommodative
    • Exotropia -Constant
    • Exotropia - Intermittent
    • Vertical Strabismus
    • All squints
    • Strabismic Amblyopia
    • Anisometropic Amblyopia
    • Ocular Motility Defects
    • Convergence Insufficiency
    • Nystamus
    • Ptosis etc
    • Refractive Errors


  • Wakefield community optometrist practices deliver a Minor Eye condition Service (MECS), formerly known as Primary Eye care and Assessment Service (PEARS). North Kirklees community optometrist practices also deliver a Primary Eye care and Assessment Service (PEARS). GP's can refer to these services where there is any doubt about diagnosis of an eye condition, or where there is a need for a second opinion. Where needed the community optometrist can then refer to a consultant-led service.

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • There is an indication, as per the guidelines, for either an acute referral to the Mid-Yorkshire Hospitals NHS Trust, which should be made for the patient to be seen either in 24 or 48 hours of initial patient presentation, or an urgent referral to the Mid-Yorkshire Hospitals NHS Trust, which should be made within one week of patient presentation.

Investigations

Undertake the following to aid diagnosis, inform management or prior to referral:

Referral

Referral Criteria

  • Referrals can be made to Community optometrist practices (Wakefield) and Community optometrist practices (NK) where there is any doubt about diagnosis of an eye condition, or where there is a need for a second opinion.
  • Please refer to The Ophthalmology Referral Guidelines which use a traffic light approach to indicate:
    • the urgency of referral
    • where referral is indicated
  • For each listed condition in the guidelines there is a brief description indicating the criteria for referral
    • RED and AMBER indicate - Acute and Urgent Referrals which should be made to the Mid-Yorkshire Hospitals NHS Trust.
    • GREEN indicates - Routine referrals which may be made to a consultant-led ophthalmology service
  • Please note that the community opthalmology service is only for Wakefield patients aged 18 or over. All children and orthoptic referrals (under 18 years of age) should be sent to the hospital based ophthalmology service

Referral Requirement

  • For Cataract Surgery referrals documented evidence is required to demonstrate that the patient meets commissioning statement criteria
  • For those patients who do not meet the eligibility criteria evidence of prior approval authorisation is required

Commissioning Statement:

Referral instructions

  • e-Consultation is not available for this specialty
  • Acute referrals should be sent to the Acute Eye Department at Pinderfields Hospital Wakefield by contacting: Acute Helpline – 01924 541 196 or Referral Fax Line – 01924 541 197
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training referrals should be made via eRS
  • Please identify speciality and clinic type
  • Routine Referrals to Community Ophthalmology Service should be made to MYHT or to one of the five services (Wakefield only) listed below via eRS
    • The Practice Ophthalmology Service - Tel:01977 502057
    • Phoenix Health Solutions - Tel: 01977 642412
    • The Grange -Tel: 01977 624270
    • Living Care - Tel: 0113 2494655

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation. If relevant patients should be signposted to decision aid for: Cateracts

Patient information/Public Health/Self Care

Evidence/additional information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: OP1 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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