This guideline last updated 07/05/2022 9:31:11

Differential diagnosis

• Primary Open Angle Glaucoma
• Primary Angle Closure or Primary Angle Closure Glaucoma
• Secondary Open Angle glaucoma

Possible management by Optometrist

Treatment

• None

Advice

• For patients with ocular hypertension, treated or untreated, a reliable baseline based on repeated measurement of intraocular pressure and perimetry should be established
  • Intraocular pressure measurement using Goldmann Applanation Tonometry
  • Gonioscopy
  • Central corneal thickness (CCT) measurement
  • Visual field measurement using standard automated perimetry and optic disc assessment
• Monitor in the community every 24 months
  • Intraocular pressure > 21 & ≤ 25mm Hg, if CCT ≥ 555 µm
• Refer to ophthalmologist in following circumstances
  • Intraocular pressure > 25mm Hg
  • Intraocular pressure 21-25mm Hg if
    • CCT < 555 µm
    • & patient aged ≤ 65

Management Category

• Monitor discharged stable low risk or treated ocular hypertension as per NICE guidance
  • Re-refer patients
    • according to advice on discharge letter
    • if intraocular pressure control is sub-optimal
    • if glaucomatous changes develop
    • if topical therapy not tolerated (allergy/toxicity)

Possible management by Ophthalmologist

• Observation
• Topical ocular hypotensive therapy
• Selective Laser Trabeculoplasty