Ocular Oncology Referral Guidelines - Scotland

National Services Division

Scottish Ocular Oncology Service

These guidelines are not intended to be prescriptive but to act as an aid to considering referral of patients to the nationally designated ocular oncology centre in Scotland at Gartnavel General Hospital. Glasgow. Referring ophthalmologists should continue to exercise discretion based on the individual clinical presentations of their patients.

1. Whom to refer to the Service

1.1 Patients with intraocular tumours

• Any primary intraocular tumour other than naevus
• Any intraocular metastatic tumour if specialist ocular oncology is required
• Suspected intraocular lymphoma.

1.2 Patients with conjunctival and epibulbar tumours that appear invasive

1.3 Refer patient with conjunctival melanocytic tumour if :

• Cornea, caruncle, and/or palpebral conjunctiva is/are involved
• Feeder vessels are present
• Nodule is associated with diffuse pigmentation
• Diameter exceeds 3 mm, especially in absence of clear cysts.

1.4 Patients with a suspicious melanocytic choroidal tumour having:

A: One of the following:

• Thickness greater than 2.0 mm
• Collar-stud configuration
• Documented growth

B: Two of the following:

• Thickness > 1.5mm
• Orange pigment
• Serous retinal detachment
• Symptoms.

1.5 Refer patient with an iris nodule if:

• Tumour is more than 3.0 mm in diameter
• Tumour is markedly elevated
• Secondary glaucoma or cataract
• Tumour involves angle.

1.6 Patients with adnexal and orbital tumours if:

• Eyelid tumour where ulceration and lash loss are evident or recurrence has occurred
• Orbital tumours.

2. Whom not to refer

• Congenital hypertrophy of retinal pigment epithelium
• Simple naevi, if:

(A) small and flat, or

(B) minimally raised with only drusen on the surface