What are the key clinical signs and symptoms that should prompt a referral for suspected glaucoma?

Key clinical signs and symptoms prompting referral for suspected glaucoma include:

• Optic nerve head damage detected on stereoscopic slit lamp biomicroscopy or optic nerve imaging (e.g., OCT) indicating glaucomatous changes.
• Visual field defects consistent with glaucoma identified by standard automated perimetry (central visual field assessment).
• Intraocular pressure (IOP) of 24 mmHg or more measured by Goldmann-type applanation tonometry.
• Peripheral anterior chamber configuration and depth abnormalities assessed by gonioscopy or van Herick test, to exclude angle-closure glaucoma.
• Symptoms of visual field loss, although early glaucoma is often asymptomatic, so objective findings are critical.

Referral should be considered after repeat confirmation of these findings unless urgent clinical circumstances exist. Non-contact tonometry alone should not be used as a sole basis for referral. All examination results should accompany the referral to ophthalmology for further assessment and diagnosis.