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SIERRA NEVADA MEDICAL ASSOCIATES, INC. (IPA)
UTILIZATION GUIDELINES
PRIMARY CARE MANAGEMENT GUIDELINES
OPHTHALMOLOGY
The Primary Care Physician should:
1. Perform a thorough ophthalmologic history including symptoms and subjective
visual acuity.
2. Provide common eye-related services including distant, near, and color vision
testing, gross visual field testing, gross visual testing by confrontation, alternate
cover testing, physical exam including direct fundoscopy without dilatation, extra
ocular muscle function evaluation, and red reflex testing in pediatric patients.
 Consider referral if the PCP is not comfortable with vision screening in
pediatric patients.
3. Diagnose and treat common eye conditions including viral (except for herpes),
bacterial, and allergic conjunctivitis, blepharitis, hordeolum, chalazion, small
conjunctival hemorrhage and photophobia.
4. Remove corneal foreign bodies that are easily removed (for example with a Q-tip)
and treat corneal abrasions.
 Referral is appropriate for patients with deeply embedded corneal foreign
bodies, or patients with high-speed foreign body injuries when the possibility
of intraocular penetration is considered.
 Referral is appropriate for patients with metal foreign bodies that are not
easily removed. Removal of a residual rust ring deposit may be necessary a
day or two following removal of a metallic corneal foreign body.
5. Referral is appropriate for:
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sudden visual change or loss.
visual change accompanied by pain or any unexplained pain.
any eye symptom not responding to treatment.
unexplained abnormality on fundoscopic exam.
pediatric patients with disconjugate gaze.
lens opacification if associated with intolerable visual impairment.
sudden onset of light flashes and floaters to rule out a retinal tear or
detachment.
all infants less than 36 weeks gestation or with birth weights of less than
2000 gms to examine for retinopathy of prematurity. This should be done at
discharge and again at three to six months of age.
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juvenile rheumatoid arthritis patients.
glaucoma patients.
Patients with glaucoma should be followed by an ophthalmologist about
every three months to assess the adequacy of their treatment. Visual
field tests are typically performed once a year if the intraocular
pressure seems to be adequately controlled and the nerve exam
appears stable. The fields may be necessary as often as every few
months in unstable cases of glaucoma. Glaucoma suspect patients
are typically followed on a less frequent basis, depending upon various
factors, including family history, level of eye pressure, appearance of
the nerve, and findings on initial visual field studies.
Macular degeneration.
Patients with macular degeneration may require follow up with an
ophthalmologist every six to twelve months.
Herpes.
Consultation is recommended when there is a high index of suspicion for
herpes, such as prior history of herpes, the presence of a dendritic
lesion, or when there is a poorly healing abrasion (particularly if
associated with minimal trauma).
 All cases of herpes zoster involving the periocular dermatomes
should be referred to rule out associated iritis or corneal
infection.
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