American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

COVID-19 Guidelines for Triage of Ophthalmology Patients

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The American Academy of Ophthalmology has released recommendations regarding urgent and nonurgent patient care. According to the statement, all ophthalmologists should cease providing any treatment other than urgent or emergent care immediately. This includes both office-based care and surgical care. For specific procedures, see table below.

List of Urgent/Emergent Ophthalmic Surgeries
March 27, 2020

Surgical Procedure

Indications


Biopsy of orbit

Suspected intraocular malignancy or immediate sight-threatening condition

Biopsy of temporal artery

Suspected giant cell arteritis

Brachytherapy

Intraocular malignancy

Cantholysis

Sight-threatening conditions

Canthotomy

Sight-threatening conditions

Cataract surgery

Congenital cataract in the amblyopic period, monocular patients with documented vision loss precluding driving, reading or self-care, lens-induced glaucoma, angle-closure glaucoma, acute lens complications, or severe anisometropia of fellow eye post recent lens extraction in first eye

Closure of cyclodialysis cleft

Sight-threatening hypotony due to trauma

Corneal transplantation

Pediatric patients with corneal blindness in both eyes in their amblyopic period

Decompression of dacryocele

Neonate with obstructive respiratory compromise

Decompression of orbit

Orbital tumor with impending vision loss

Drainage of abscess

Orbital cellulitis

Drainage of choroidals

Appositional choroidal effusion, suprachoroidal hemorrhage, or flat anterior chamber

Enucleation

Ocular trauma, infection, intractable glaucoma, globe perforation, intractable pain, or intraocular malignancy

Evisceration

Sight-threatening infection, or intractable pain

Examination under anesthesia

Pediatric patients with retinoblastoma, endophthalmitis, Coats Disease, uveitis, glaucoma, ocular trauma, retinal detachment, or presumed intraocular foreign body

Excision of tumors

Malignancy or sight-threatening tumor

Exenteration

Life-threatening infection

Exploration of orbit

Life-threatening or sight-threatening conditions

Fenestration of optic nerve sheath

Progressive vision loss

Filtration surgery

Uncontrolled intraocular pressure that is sight-threatening who are poor candidates for trabeculectomy or aqueous tube shunts

Frontalis sling

Sight-threatening congenital ptosis

Goniotomy ab externo or ab interno

Uncontrolled intraocular pressure that is sight-threatening

Insertion of drainage implant with or without graft

Catastrophic or rapidly progressive glaucoma

Laser indirect retinopexy – complex

Retinal detachment, retinal tear, or ocular trauma

Laser photocoagulation

Pediatric patients with retinopathy of prematurity (if this can’t be in NICU)

Pars plana lensectomy

Acute lens complications

Peeling of membrane/internal limiting membrane

Proliferative diabetic retinopathy, proliferative vitreoretinopathy, complex preretinal membrane, complex macular pathology, or macular hole

Pneumatic retinopexy

Retinal detachment

Probing of nasolacrimal duct

Dacryocystocele

Reconstruction of ocular surface or other tectonic procedures

Acute chemical injury, or acute Stevens Johnson Syndrome

Removal of aqueous drainage implant

Endophthalmitis, corneal touch, corneal decompensation, or exposed plate

Removal of intraocular foreign body

Presumed intraocular foreign body

Repair of anterior segment or cornea

Lacerations, blunt rupture, or deeply embedded corneal foreign body

Repair of canalicular laceration

Injury or trauma to their canaliculus

Repair of dehiscence of corneal graft or other anterior segment wound

Wound dehiscence or other wounds, including dislocated LASIK flaps

Repair of extrusion or complication of keratoprosthesis

Complications with implanted devices in their cornea or anterior segment

Repair of eyelid/face

Lacerations of eyelid or face

Repair of facial fractures

Displaced facial bone fractures

Repair of open globe

Ocular trauma

Repair of operative wound(s)

Bleb leaks, wound leaks, overfiltration, underfiltration, bleb scarring, sight-threatening hypotony, or shallow anterior chamber

Repair of orbital fracture

Hemodynamic instability or oculocardiac reflex

Repair of perforation or impending perforation of cornea or sclera

Corneal and scleral injury or trauma

Retrobulbar injection

Pain due to ocular diseases causing significant compromise of quality of life

Revision of drainage implant with or without graft

Implant/tube exposure that might be sight threatening, endophthalmitis, malpositioned tube endangering eye or excessive inflammation, a tube that might worsen vision due to corneal edema or iritis or cystoid macular edema, or with a severe tube malposition causing rapid visual loss

Scleral buckle

Retinal detachment, ocular trauma, intraocular infection, vitreous hemorrhage, retinal tear, or intraocular foreign body

Synechiolysis

Lens-induced glaucoma or angle-closure glaucoma

Tarsorrhaphy

Impending corneal compromise

Trabeculectomy with or without scarring

Catastrophic or rapidly progressive glaucoma and markedly elevated intraocular pressure, or uncontrolled secondary or primary glaucoma

Trabeculotomy

Uncontrolled intraocular pressure that is sight-threatening

Transscleral cyclophotocoagulation

Uncontrolled glaucoma or absolute glaucoma with a blind and painful eye

Vitrectomy

Retinal detachment, ocular trauma, intraocular infection, vitreous hemorrhage, retinal tear, intraocular foreign body, misdirected aqueous, ciliary block glaucoma, malignant glaucoma, a vitreous prolapse, or a tube shunt that blocks filtration

Washout of the anterior chamber

Hyphema that is sight-threatening