Ocular Disease: Diagnosis, Management and Referral
What this domain tests
This section tests recognition of sight-threatening and life-threatening ocular disease, appropriate urgency of referral, and safe interim management within optometric scope. New Zealand referral pathways reward clear, timely and specific communication.
Core rules and concepts
- Red flags include sudden vision loss, severe pain, fixed pupil, corneal opacity, hypopyon, flashes and floaters, and giant-cell arteritis symptoms.
- Acute angle closure is an emergency: severe pain, halos, nausea, corneal oedema and a mid-dilated fixed pupil.
- Retinal detachment with a shadow or field loss requires same-day ophthalmology assessment.
- Suspected giant-cell arteritis requires urgent medical assessment, not routine optometric follow-up.
- Referral letters should state findings, suspected diagnosis, urgency and patient contact details.
Worked example
A 68-year-old presents with acute unilateral pain, blurred vision, coloured halos and nausea. The pupil is mid-dilated and fixed; the cornea is hazy; intraocular pressure is markedly raised. Reasoning: this is acute angle closure until proven otherwise. Do not prescribe a steroid or a mydriatic; arrange immediate emergency ophthalmology care and document the findings and advice given.
Traps that cost marks
Treating a painful red eye with topical steroid before excluding herpes simplex; referring a retinal detachment routinely rather than same day; missing giant-cell arteritis in an older patient with headache and visual symptoms; failing to record urgency in the referral.
Key points
- Acute angle closure is an emergency with pain, halos and a fixed pupil.
- Same-day referral for retinal detachment with field loss.
- Giant-cell arteritis is urgent medical, not routine ocular, care.
- Never use steroid before excluding dendritic ulcer.
- Referral letters need findings, diagnosis, urgency and contacts.