Page 96 - NAME OF CONDITION: REFRACTIVE ERRORS

Referral following initial treatment if,
 Secondary glaucomas without facilities to treat the underlying cause (for example

laser iridotomy for pupil block/ surgery (ex. in microspherophakia or lensectomy
for subluxated crystalline lens)
 Nanophthalmos requiring surgery
 Previous failed trabeculectomy uncontrolled on maximum antiglaucoma therapy
 Patients requiring tube implants
 Only seeing eye
 Post congenital cataract surgery with uncontrolled IOP on therapy
 Complications of filtration surgery requiring surgical intervention
 Failing bleb
 Large choroidal haemorrhage/ effusions

 Bleb leaks
 Blebitis and endophthalmitis
*Situation 2: At Super Specialty Facility in Metro location where higher-

end technology is available
The clinical diagnosis and management is done on the same general guidelines as given
above.
a) Clinical Diagnosis:

A Perkins tonometer or Tonopen (especially in case of corneal scarring precluding the
use of a Goldmann’s tonometer) may be used for IOP measurement.
b) Investigations:
Ancillary investigations which may aid clinical diagnosis and management include

Imaging of anterior segment:
A carefully done gonioscopy remains the gold standard for diagnosis of angle closure. There
are various imaging tools to help evaluate the anterior segment of the eye. Anterior
segment optical coherence tomography and ultrasound biomicroscopy play a key role in
selected patients with angle closure. Both allow qualitative and quantitative assessment of
anterior segment of the eye, although AS-OCT is unable to assess structures posterior to the
iris.
Biometry To assess the axial length, lens thickness and anterior chamber depth (Refer ‘Risk
factors’ above)

Imaging of optic disc and nerve fibre layer
Use of HRT, GDx and OCT (Retinal nerve fiber layer assessment) (if available)
C)Treatment:
(1) Control of IOP as outlined above
(2) Angle control

Laser peripheral iridotomy

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