Clinical Statements : American Academy of Ophthalmology

Clinical Statements

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Guidelines for Appropriate Referral of Persons with Possible Eye Diseases or Injury

Policy

The American Academy of Ophthalmology supports the concept of prompt, appropriate referral of individuals to an ophthalmologist when certain signs are observed and/or certain symptoms of possible eye disease or injury are reported.

Background

Many eye diseases, systemic diseases, and injuries that affect the eyes may begin with subtle signs and either minimal or barely detectable symptoms. Most of these diseases and injuries require prompt and appropriate medical treatment in order to minimize risks of impaired vision or even blindness. Ophthalmologists are medical specialists who are qualified by education, training, and clinical experience to provide total eye care, which includes a vision examination (refraction), a medical eye examination, and necessary medical and surgical care and treatment.

Guidelines

A person who exhibits any of the following signs or symptoms should be referred promptly to an ophthalmologist for definitive diagnosis and necessary medical treatment:

Failure to achieve normal visual acuity in either eye unless the case of the impairment has been medically confirmed by prior examination and visual acuity is stabilized. (Different levels of screening visual acuity for different ages of preschool children have been established to take into account the maturity of the child.)
Significant eye injury or eye pain.
Symptoms of flashes of light; recent onset of floaters, halos, transient dimming, or distortion of vision; obscured vision; loss of vision or pain in the eye, lids, or orbits; double vision; or excessive tearing in the eye.
Transient or sustained loss of any part of the visual field, or clinical suspicion or documentation of such field loss.
Abnormalities or opacities in the normally transparent media of the eye, or abnormalities of the ocular fundus or the optic nerve head.
Tumor or swelling of the eyelids or orbit, or protrusion of one or both eyes.
Inflammation of the lids, conjunctiva, or globe, with or without discharge.
Strabismus or crossed eyes.
Intraocular pressure at an abnormal level or family history of glaucoma, especially in patients of African origin.
Diabetes mellitus.
Eye and orbital abnormalities associated with thyroid disease (Graves' disease).
Other history, symptoms, or signs that indicate the need for an ophthalmologist to perform an eye examination or treatment.

The following groups of individuals should also be referred promptly to an ophthalmologist:

HIV-positive patients with ocular symptoms and all patients with AIDS.
Newborn babies at risk, by prematurity, systemic disease, family history of conditions that cause or are associated with eye or vision problems, or serious ocular symptoms.