Signs and Symptoms

Ocular Hypertension

• No symptoms
• Raised intraocular pressure
• Normal optic disc and visual fields

Open-Angle Glaucoma Suspect

• No symptoms
• Optic disc appearance or pattern of visual field loss suggestive of possible glaucoma
• Normal intraocular pressure

Chronic Open-Angle Glaucoma

• No symptoms
• Rarely blurred or 'patchy' vision
• Glaucomatously damaged optic disc or glaucomatous pattern of visual field loss
• Intraocular pressure raised or normal
• Open drainage angle

Acute Angle-Closure Glaucoma

• Severe ocular pain, haloes around lights, reduced vision
• Conjunctival injection, dull corneal reflex, pupil enlarged and poorly reactive to light, raised intraocular pressure (typically more than 40mmHg)

Intermittent Angle-Closure Glaucoma

• Intermittent blurred vision, ocular pain (mild or severe) +/- haloes around lights
• Symptoms typically worse in dim light and alleviated by sleep

Chronic Angle-Closure Glaucoma

• No symptoms
• Rarely blurred or 'patchy' vision
• Glaucomatously damaged optic disc or glaucomatous pattern of visual field loss
• Narrow/closed drainage angle

History and Examination

GP

• Previous medical history including medications/allergy list and family history
• BMI
• Mobility
• Need for interpreter

Optometrist

• Previous ocular history
• Ocular family history
• Anterior segment examination findings
• Goldmann intraocular pressure
• Drainage angle assessment (gonioscopy or van Herricks)
• Optic disc assessment
• Visual fields

Symptoms/signs of intermittent or acute angle-closure glaucoma

Intraocular pressure greater than 31mmHg 

Urgent Care Services For healthcare staff only:

Anyone who needs to be seen immediately, or within 48 hours for the ophthalmic emergency service, should be referred by Telephone call to Urgent referral nurses Telephone 01803 654926 (for GP's and Opticians only) from 9am to 5pm, Monday to Friday.

Contact the on-call service via switchboard for out of hours help on 0300 456 8000 or 01803 614567.

Previous records/information from other providers including:

• letters
• optic disc imaging
• visual fields
• ocular laser/surgery records

Ocular Hypertension:

• Repeat intraocular pressure measurement as per OHT refinement scheme

Other conditions described above:

• Refer to secondary care

Referral Criteria

The referrer must confirm that the patient understands that the purpose of the referral is for assessment to determine appropriate management

Referrals must include a DRSS referral form or Opticians referral form and accompanying information from the GP inclusive of information detailed above

Referral Instructions

e-Referral Service Selection

• Specialty: Ophthalmology
• Clinic Type: Glaucoma
• Service: DRSS-NES-Ophthalmology (not for patient attendance)-Devon ICB-15N

Referral Forms

GP referral form

Opticians referral form

This guidance has been signed off by NHS Devon

Publication date: November 2016

Updated: January 2023