These are general guides, however, each case should be taken on its own merit and management will depend upon the precise clinical scenario. If in doubt contact the ophthalmology department for advice.
Sometimes you will receive reports from optometrists asking you to take over care or informing you about their findings. Optometrists are highly trained professionals and tend to be excellent at diagnosing and managing a wide variety of ophthalmic conditions. Follow their guidance but if in doubt hopefully the information below will be of some assistance. Again, it must be emphasised that this is general guidance and each case must be taken on its merits. If in doubt contact your ophthalmologist for advice.
If a condition you want to know about is not here let us know and we will add a section on it shortly.
This is a retinal cyst and not a detachment. It is a hard diagnosis to make and so the optometrist may require confirmation from the ophthalmology department. Refer routinely. Warn patients about the symptoms of retinal detachment
If the scar is inactive, there is no need to refer. Scars are common and some are of an unknown origin. Old toxoplasmosis scars are extremely common and require no treatment or investigation. A scar in isolation does not require referral, unless there is the suspicion of an active progressive process. Old toxoplasmosis scars can reactivate but this will be associated with other symptoms, such as blurred vision.
Check the red reflexes, comparing both sides. These are often hard to see in dark-skinned babies. If the baby has a white pupillary reflex there is something seriously wrong – refer urgently.
In neonates, a clear visual axis is vital for the development of normal vision. If the baby has a cataract, the risk of long-term visual morbidity is high and the patient should be referred urgently via letter.
If the baby has already developed nystagmus, there is an urgent need for paediatric ophthalmology review.
It is important to find out whether the parents have noticed the squint. The risk of amblyopia is high if the squint is long-standing and constant in nature.
Examine the corneal reflexes to see if the baby does indeed have a squint. Ignore the amount of sclera showing – concentrate on the light reflex on the cornea. Prominent folds of skin at the inner canthus can fool the examiner into thinking that the baby has a convergent squint. It is probably best to refer all such babies, as only an assessment by an orthoptist will determine for certain that ocular alignment is normal.
Such babies should be referred soon via letter, either to the paediatric ophthalmologist or direct to the orthoptic services, if this route of referral is available to you.
This patient is at risk of vitreous haemorrhage and significant visual loss – refer urgently via letter.