Tertiary Care Guidelines for New Patient Referrals to KKESH
Anterior Segment
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All corneal disorders possibly requiring transplantation, including penetrating and
lamellar keratoplasty, epikeratoplasty
Difficult cataracts with at least one additional risk factor (previous pars plana
vitrectomy, posterior synecchia, small pupil) or one additional major ophthalmic
problem (severe glaucoma, significant diabetic retinopathy, corneal scarring with
impaired visualization of the anterior segment), or monocular status
Severe or sight-threatening microbial keratitis: HSV, HZV, bacterial, fungal parasitic
Ocular surface disorders possibly requiring transplantation, including conjunctival,
amniotic membrane, or mucous membrane grafts
Pterygium threatening the visual axis, compromising vision due to high astigmatism,
or producing diplopia due to restriction of extraocular movement
Conjunctival shrinkage disorders such as ocular cicatricial pemphigoid requiring
possible immunosuppressive therapy
Severe of sight-threatening atopic or vernal keratoconjunctivitis
Severe or sight-threatening scleritis or autoimmune peripheral keratitis
Anterior segment tumors: conjunctiva, cornea, iris
Keratorefractive patients with:
a. Myopia >6 diopters (21 years of age or older)
b. Hyperopia >2 diopters (21 years of age or older)
c. Astigmatism >3 diopters
d. Anisometropia >3 diopters
Glaucoma
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Congenital glaucoma
Advanced or complicated forms of glaucoma
Normal or low-tension glaucoma with progressive optic neuropathy and visual field
deterioration
One-eyed patients with advanced glaucoma
Neuro-ophthalmology
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Papilledema/optic nerve swelling
Acute optic neuritis/neuropathy
Optic atrophy
Pupillary disorders
Oculomotor disturbances
Central nervous system disorders with involvement of the visual or oculomotor
system
Vascular disorders with involvement of the visual or oculomotor system
Congenital, metabolic, infectious, and toxic disorders involving the eye and visual
system
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Tertiary Care Guidelines for New Patient Referrals to KKESH
Oculoplastic and Orbit
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Tumors of the lids, adnexa, and orbit
Inflammatory disorders of the eyelids, adnexa, and orbit
Infections of the orbit
Severe infections of the eyelids and adnexa
Disorders of the lacrimal drainage system with associated infections or clinically
significant epiphora
Entropion or Entropion severe enough to cause ocular surface damage
Trauma of the eyelids, adnexa, and orbit requiring surgical repair
Clinically and functionally significant ptosis
Congenital defects of the eyelids, adnexa, and orbit
Conjunctival shrinkage syndromes requiring mucous membrane grafting and/or
eyelid repair or reconstruction
Prosthesis fitting or care
Uveitis
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Complex cases of uveitis requiring systemic evaluation, medical intervention with
immunosuppressive therapy, or surgical intervention
Active uveitis with secondary complications such as cataract, glaucoma, or retinal
detachment
All cases of posterior uveitis
Anterior uveitis that results from “spillover” of posterior uveitis
Pediatric Ophthalmology
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Do not refer neonates who weight less than 3 kilograms since there is no neonatal
ICU at KKESH. Consider referral of such cases to the King Fahad Medical City.
New congenital glaucoma cases
Leukocoria/suspected ocular or orbital tumors
Congenital or acquired opacities of cornea/lens/vitreous
Sight or life-threatening ocular and/or orbital infection or inflammation (such as
orbital cellulites or endophthalmitis, but NOT chalazion, hordeolum, blepharitis, or
conjunctivitis)
Amblyopia in children less than 9 years
Ocular deviation:
a. Children less than 9 years
b. Paralytic strabismus, irrespective of age
c. Vertical deviations, irrespective of age
d. Unacceptable ocular alignment after previous squint surgery
e. Acquired binocular diplopia
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Tertiary Care Guidelines for New Patient Referrals to KKESH
Vitreoretinal
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Acute endopthalmitis
Trauma requiring vitreoretinal expertise
Retinal detachment or retinal tears requiring treatment
Diabetic patients with proliferative retinopathy, severe non-proliferative retinopathy,
or maculopathy
Diabetic patients referred from centers where laser equipment is not available
Age related macular degeneration with suspected choroidal neovascularization
Choroidal neovascularization (macular and juxtapapillary) irrespective of etiology
Retinal neovascularization
Acute vitreous hemorrhage
Retinopathy of prematurity (must be >3 kilograms for referral). Consider referral of
such cases to the King Fahad Medical City
Central or retinal branch artery occlusion
Central or retinal branch vein occlusion
Congenital, genetic, metabolic, or toxic retinal disorders
Retinal tumors requiring treatment
Choroidal tumors requiring treatment
Vitreous disorders that predispose to retinal damage
Optometric Services
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Low vision evaluations
Keratoconus patients requiring contact lens evaluation and fitting
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