Investigation and referral guidelines for optometrists

Domains: Clinical practice, Communication

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Papilloedema is swelling of the optic nerves at the back of both eyes caused by raised intracranial pressure. Papilloedema is significant because it can be the first sign of life-threatening disease, eg brain tumours, hydrocephalus, cerebral venous sinus thrombosis. But the diagnosis of papilloedema can be difficult. It takes training to recognise papilloedema and interpret the results of specialist imaging tests, like optical coherence tomography (OCT), which help distinguish papilloedema from conditions which mimic it. 

While OCT is a great clinical tool to aid optic disc assessment in community optometry practice, it can also lead to many unnecessary referrals without the necessary training to interpret the results correctly. It is important that optometrists maintain their clinical skills in history taking and examination techniques, and do not lose sight of more traditional methods to assess optic discs accurately in conjunction with the patient’s symptoms.

This recorded lecture covers the following points:

  • Clinical symptoms of serious neurological diseases that cause headache and/or papilloedema
  • Differential diagnosis of the more common causes of unilateral/bilateral optic disc swelling and pseudopapilloedema
  • Optic disc examination:
    • Indirect ophthalmoscopy
    • OCT
  • Recommendations about when to refer and where to refer patients to, safely and appropriately
  • Record-keeping and patient communication

Last published: December 2022

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    s.2 Communicate effectively with patients

    • Able to ask appropriate questions to elicit symptoms that may indicate serious neurological disease in patients presenting with suspect optic disc swelling.

    Clinical Practice

    s.5 Keep your knowledge and skills up to date

    • Understand the more common causes of unilateral/bilateral optic disc swelling and pseudopapillodema and so be able to recognise and differentiate signs of neurological significance and refer appropriately.

    s.7 Conduct appropriate assessments, examinations, treatments and referrals

    • Understand how to examine the optic discs effectively and interpret the results of specialist imaging tests such as OCT.

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