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  Cases needing specialized investigations (e.g USG B-Scan, Electrophysiological tests)

                      Cases not manageable by the facilities available .
                      Seeking second opinion
                      Complications needing specialized intervention.
                      Complex cases like torsional deviation, DVD, Duanes retraction syndrome etc.,needs
                       referral


                *Situation 2: At Super Specialty Facility in Metro location where higher-

                end technology is available
                a)  Clinical Diagnosis: Same as situation 1 plus better orthoptic examination.



                b)  Investigations: Same as situation 1. In addition, USG B Scan and electrophysiological
                     tests are done if needed. Paediatric and neurological consultation back up and facility
                     for relevant systemic investigations is required in indicated patients.

                c)  Treatment:

                     Same  as  situation1.  In  addition,  the  ophthalmologist  should  be  able  to  take  up
                     complex  surgeries.  Interdiscipinary  referral  between  the  anterior  and  posterior
                     segment  specialists  is  required  in  certain  cases.  Low  vision  aids  may  be  required  in
                     some individuals

                Standard Operating procedure

                a. In Patient

                      Patients preferring hospital stay for surgery because of distance and better care
                        If decided by the Anaesthesiologist
                      Patients needing some adjustment of sutures on the next day
                      Patients with post operative complications that need institutional care

                b. Out Patient
                Non surgical treatment; Pre operative investigations; Follow up
                c. Day Care
                If patients prefer and are able to reach the clinic easily if required

                d) Referral criteria:

                Does not apply

                VI. WHO DOES WHAT? and TIMELINES


                a.  Doctor




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