Glaucoma suspect referral: what to check and when to refer
The short answer
Refer a glaucoma suspect when you find a suspicious optic disc, a repeatable visual field defect or an eye pressure of 24 mmHg or more on applanation tonometry, ideally confirmed on a second occasion. NICE advises against referring on non-contact tonometry alone. Suspected acute angle closure is an emergency, the same day.
Refer a patientMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
Who to refer
- Adults with an optic disc that looks glaucomatous: cupping, rim thinning or notching, disc haemorrhage, or asymmetry between the eyes.
- Adults with a visual field defect consistent with glaucoma that repeats on a second test.
- Adults with intraocular pressure of 24 mmHg or more on Goldmann-type applanation, confirmed on another occasion.
- Anyone with a narrow or occludable angle on gonioscopy or van Herick assessment.
- First-degree relatives of people with glaucoma who have any of the findings above.
How urgently
Same day
Suspected acute angle closure: a painful red eye, haloes, blurred vision, a mid-dilated pupil, nausea or headache, with high pressure. Send the patient to an eye emergency service now.
Soon
Very high pressure without symptoms, or advanced field loss or disc damage found for the first time.
Routine
A suspicious disc, a repeatable field defect or pressure of 24 mmHg or more, with no symptoms.
What to send with the referral
- Intraocular pressure for each eye, the method used (applanation or non-contact) and the time of day.
- Your optic disc findings, with OCT or disc images if you have them.
- The visual field results, including the repeat test if you did one.
- Your anterior chamber angle assessment: gonioscopy, or van Herick.
- Family history of glaucoma, any steroid use, and other relevant health such as diabetes or high blood pressure.
Repeat before you refer, unless it is urgent
NICE asks primary eye care professionals to consider repeating the field test and the pressure measurement on another occasion before referring, unless the clinical picture calls for urgent referral. A repeat helps avoid referrals for readings that do not hold, and lets the specialist start from confirmed findings.
Send every result with the referral. A referral that arrives with the fields, the pressures and the disc findings can be triaged on the day it lands.
What you get back
- An acknowledgement email with the referral reference as soon as you submit.
- A loop-back letter from the receiving clinician once the patient has been seen: what was found, what was done and the plan.
- The patient returned to you for ongoing care, with the plan in the letter, so you keep the person you looked after.
- A named specialist and a care coordinator who calls the patient, so the referral does not sit unanswered.
Mezo pays nothing for referrals: no fee, credit, points or discount per patient, to anyone. You refer because it is the right place for the patient, and you hear back how it went.
Refer a patient
For selective laser trabeculoplasty, slt or an assessment. No Mezo account needed. The receiving specialist and a care coordinator take it from here.
Common questions
Can I refer on a non-contact tonometry reading?
NICE advises against basing a referral solely on non-contact tonometry. Confirm with Goldmann-type applanation where you can, and send the method with the reading.
Who manages the patient after the diagnosis?
The specialist confirms the diagnosis and sets the plan. Where the patient is stable, monitoring can return to you, and the letter says what to check and when.
Does Mezo pay referrers?
Mezo pays nothing for referrals: no fee, credit, points or discount per patient, to anyone. You refer because it is the right place for the patient, and you hear back how it went.
Guides to send your patient
Patient health guides
The treatment
More referral guidance
Sources and further reading
The guidelines and patient information this page is checked against. Care in Nigeria follows the same evidence; what differs is the price and where it is done.
- Glaucoma: diagnosis and management (NG81). National Institute for Health and Care Excellence, 2017. Clinical guideline.
- Clinical Management Guidelines: Glaucoma (primary open angle). College of Optometrists. Clinical guideline.
- Clinical Management Guidelines: Ocular hypertension. College of Optometrists. Clinical guideline.
- Clinical Management Guidelines: Primary angle closure and primary angle closure glaucoma. College of Optometrists. Clinical guideline.
- Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern. American Academy of Ophthalmology. Clinical guideline.
Links last checked 23 October 2026.