What are the criteria for urgent referral of a patient with suspected acute angle-closure glaucoma to an ophthalmologist?

Criteria for urgent referral of a patient with suspected acute angle-closure glaucoma to an ophthalmologist include:

• Presence of symptoms suggestive of acute angle-closure glaucoma such as sudden onset of eye pain, redness, blurred vision, halos around lights, headache, nausea, or vomiting (implied by the need for urgent referral in acute angle-closure cases).
• Clinical signs indicating angle closure such as a shallow anterior chamber on examination (e.g., van Herick test or gonioscopy) and elevated intraocular pressure (IOP) measured preferably by Goldmann applanation tonometry.
• Urgent referral is indicated when clinical circumstances suggest an emergency, such as markedly raised IOP or acute symptoms, without waiting for repeat measurements (as per recommendation to consider urgent or emergency referral if clinical circumstances indicate) ¹.
• Referral should be made promptly to a consultant ophthalmologist for definitive diagnosis and management planning, especially if angle closure is suspected, to prevent sight loss ¹.

Note: Although the provided NICE guideline excerpts focus primarily on chronic open angle glaucoma and related conditions, they emphasize that urgent or emergency referral is warranted when clinical circumstances indicate, such as in acute angle-closure glaucoma, which is an ophthalmic emergency requiring immediate specialist assessment ¹.