Prescriptive Authority and Referral Obligations
What this domain tests
This domain tests therapeutic prescribing, controlled-substance rules, and the duty to refer when a patient's condition is outside optometric scope or fails to respond as expected.
Core rules
- Mississippi optometrists may prescribe diagnostic and therapeutic pharmaceutical agents for conditions of the eye and adnexa as authorized by the Practice Act and Board rules.
- Prescribing must stay within ocular scope. A drug prescribed for a non-ocular condition, or a dose or duration beyond the rule, is outside authority even if clinically tempting.
- Controlled substances require a valid DEA registration and compliance with federal and Mississippi controlled-substance law. Schedule I substances are not prescribable; other schedules are limited by statute and rule.
- Referral is required when the condition exceeds scope, when diagnosis is uncertain, or when the patient is not improving. Emergency conditions require immediate referral, not a routine appointment.
- Document the drug, dose, directions, quantity, refills, counseling, and referral.
Worked example
A patient has unilateral eyelid swelling, fever, and pain on eye movement. The optometrist considers oral antibiotics for preseptal cellulitis. Reasoning: pain on movement and fever suggest orbital cellulitis, which is outside optometric management and requires urgent medical referral. Prescribing and watching would delay care. The record should show the suspected diagnosis, the referral, and the time.
Traps
Prescribing for a family member or self; using a DEA number after it lapses; failing to document verbal referrals; treating "red eye" with a steroid without considering herpes or infection.
Key points
- Prescriptive authority is limited to ocular conditions and the statutory formulary.
- Controlled substances require DEA registration and legal compliance.
- Orbital cellulitis and other emergencies require immediate referral.
- Document the prescription and the referral.
- Do not prescribe outside scope even for convenience.