Potentially occludable angle as judged by Van Herick test
Patients with peripheral anterior chamber width of one quarter or less of the corneal thickness (Van Herick < Grade 2) should be referred
Primary Angle Closure Suspect
Can only be diagnosed by Gonioscopy
The decision to refer for further treatment should be based on the risk of developing primary angle closure / primary angle closure glaucoma or acute angle closure
If not referring, monitor closely with serial gonioscopy
Patients should be aware that they are at risk of occlusion and that certain medications could induce angle closure
Urgent (within one week) referral to ophthalmologist
Primary Angle Closure Suspect
Routine referral to ophthalmologist
Possible management by Ophthalmologist
Peripheral iridotomy
Lens extraction
×
Introduction and disclaimer
The eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical
decision support and is intended for use by ophthalmic healthcare professionals.
The Website is not intended for use by the general public and does not replace the advice of a healthcare professional.
Members of the public should seek advice directly from their optometrist.
The guidelines on the Website were originally adapted from The College of Optometrists’ Clinical Management Guidelines
(CMGs), to incorporate pragmatic experience gained from NHS Grampian’s Eye Health Network. However, this content is currently under review.
The most up-to-date versions of The College of Optometrists’ CMGs can be accessed
at https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines.
The information on the Website provides guidance and related information for the differential diagnosis, possible
management by optometrists (treatment and advice), management category and possible management by ophthalmologists.
Users should note that that the guidance on the Website will not be suitable for every situation and is not intended to be a
substitute for specialist expertise and clinical judgement. Users should also note that this guidance should not be adhered to
in isolation and should be considered in conjunction with other national and locally available guidance/pathways.
While the Common Services Agency (“NSS”) makes reasonable efforts to ensure that the information on the Website is correct,
the Website is provided ‘as is’ and NSS does not warrant the accuracy and completeness of the material on the Website. NSS may
make changes to the Website at any time without notice. Some of the material on the Website may be out of date, and NSS makes
no commitment to update such material. Users should note that some guidelines on the Website have not been updated for several years
and should be considered with caution. Where the Website contains links to other sites and or resources provided by third parties,
these links are provided for information only. NSS has no control over, and no liability in respect of, the content of these sites and resources.
Accordingly, to the maximum extent permitted by law, the Website is made available by NSS on the basis that NSS excludes all representations, warranties,
conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose
and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Website.
Users assume all responsibility for using the information on the Website.
