Tertiary Care Guidelines for New Patient Referrals to KKESH

Tertiary Care Guidelines for New Patient Referrals to KKESH Anterior Segment 1. 2.

3. 4. 5. 6. 7. 8. 9. 10.

All corneal disorders possibly requiring transplantation, including penetrating and lamellar keratoplasty, epikeratoplasty Difficult cataracts with at least one additional risk factor (previous pars plana vitrectomy, posterior synecchia, small pupil) or one additional major ophthalmic problem (severe glaucoma, significant diabetic retinopathy, corneal scarring with impaired visualization of the anterior segment), or monocular status Severe or sight-threatening microbial keratitis: HSV, HZV, bacterial, fungal parasitic Ocular surface disorders possibly requiring transplantation, including conjunctival, amniotic membrane, or mucous membrane grafts Pterygium threatening the visual axis, compromising vision due to high astigmatism, or producing diplopia due to restriction of extraocular movement Conjunctival shrinkage disorders such as ocular cicatricial pemphigoid requiring possible immunosuppressive therapy Severe of sight-threatening atopic or vernal keratoconjunctivitis Severe or sight-threatening scleritis or autoimmune peripheral keratitis Anterior segment tumors: conjunctiva, cornea, iris Keratorefractive patients with: a. Myopia >6 diopters (21 years of age or older) b. Hyperopia >2 diopters (21 years of age or older) c. Astigmatism >3 diopters d. Anisometropia >3 diopters

Glaucoma 1. 2. 3. 4.

Congenital glaucoma Advanced or complicated forms of glaucoma Normal or low-tension glaucoma with progressive optic neuropathy and visual field deterioration One-eyed patients with advanced glaucoma

Neuro-ophthalmology 1. 2. 3. 4. 5. 6. 7. 8.

Papilledema/optic nerve swelling Acute optic neuritis/neuropathy Optic atrophy Pupillary disorders Oculomotor disturbances Central nervous system disorders with involvement of the visual or oculomotor system Vascular disorders with involvement of the visual or oculomotor system Congenital, metabolic, infectious, and toxic disorders involving the eye and visual system

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Tertiary Care Guidelines for New Patient Referrals to KKESH Oculoplastic and Orbit 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Tumors of the lids, adnexa, and orbit Inflammatory disorders of the eyelids, adnexa, and orbit Infections of the orbit Severe infections of the eyelids and adnexa Disorders of the lacrimal drainage system with associated infections or clinically significant epiphora Entropion or Entropion severe enough to cause ocular surface damage Trauma of the eyelids, adnexa, and orbit requiring surgical repair Clinically and functionally significant ptosis Congenital defects of the eyelids, adnexa, and orbit Conjunctival shrinkage syndromes requiring mucous membrane grafting and/or eyelid repair or reconstruction Prosthesis fitting or care

Uveitis 1. 2. 3. 4.

Complex cases of uveitis requiring systemic evaluation, medical intervention with immunosuppressive therapy, or surgical intervention Active uveitis with secondary complications such as cataract, glaucoma, or retinal detachment All cases of posterior uveitis Anterior uveitis that results from “spillover” of posterior uveitis

Pediatric Ophthalmology 1. 2. 3. 4. 5.

6. 7.

Do not refer neonates who weight less than 3 kilograms since there is no neonatal ICU at KKESH. Consider referral of such cases to the King Fahad Medical City. New congenital glaucoma cases Leukocoria/suspected ocular or orbital tumors Congenital or acquired opacities of cornea/lens/vitreous Sight or life-threatening ocular and/or orbital infection or inflammation (such as orbital cellulites or endophthalmitis, but NOT chalazion, hordeolum, blepharitis, or conjunctivitis) Amblyopia in children less than 9 years Ocular deviation: a. Children less than 9 years b. Paralytic strabismus, irrespective of age c. Vertical deviations, irrespective of age d. Unacceptable ocular alignment after previous squint surgery e. Acquired binocular diplopia

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Tertiary Care Guidelines for New Patient Referrals to KKESH Vitreoretinal 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Acute endopthalmitis Trauma requiring vitreoretinal expertise Retinal detachment or retinal tears requiring treatment Diabetic patients with proliferative retinopathy, severe non-proliferative retinopathy, or maculopathy Diabetic patients referred from centers where laser equipment is not available Age related macular degeneration with suspected choroidal neovascularization Choroidal neovascularization (macular and juxtapapillary) irrespective of etiology Retinal neovascularization Acute vitreous hemorrhage Retinopathy of prematurity (must be >3 kilograms for referral). Consider referral of such cases to the King Fahad Medical City Central or retinal branch artery occlusion Central or retinal branch vein occlusion Congenital, genetic, metabolic, or toxic retinal disorders Retinal tumors requiring treatment Choroidal tumors requiring treatment Vitreous disorders that predispose to retinal damage

Optometric Services 1. 2.

Low vision evaluations Keratoconus patients requiring contact lens evaluation and fitting

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