Pediatric Ophthalmology Resources for Healthcare Professionals

At Children's Hospital Colorado, we're committed to helping all healthcare professionals raise the quality of life for children with ophthalmologic conditions. Get the latest in pediatric ophthalmology information to help improve your practice and learn about our recent advancements.

How to refer to our pediatric ophthalmologists

To refer a patient, you can:

• Call 720-777-2020 and say ‘physician office’ when prompted.
• Fax a referral to 720-777-7974.
• Submit a referral through EpicCare Link or PedsConnect™ if you are enrolled. 

Referral guidelines for ophthalmology

Below you’ll find referral guidelines for specific ophthalmologic conditions.

Referral guidance for nasolacrimal duct obstruction

A conversation with the family should include a discussion of symptoms. If the patient has recurrent episodes of cellulitis related to nasolacrimal duct obstruction, treat the cellulitis and refer to ophthalmology within two months.

An initial physical exam should ensure the absence of a nasolacrimal duct cyst (dacryocystocele). If there is a possibility of a nasolacrimal duct cyst, refer to ophthalmology immediately. If an infant is experiencing respiratory problems related to a nasolacrimal duct cyst, immediately refer to the emergency department to secure the airway. The initial examination should also consider the relative size of each eye to evaluate for congenital glaucoma, which can present with an enlarging eye (buphthalmos), tearing and frequent blinking.

For uncomplicated nasolacrimal duct obstruction (without the above red flag features), the primary care team can manage conservatively with warm compresses to remove the debris from the eyelashes as needed. Ophthalmology will offer surgical management for these patients after 12 months of age.

Referral guidance for stye, chalazion and hordeolum

Most styes and chalazia seen in ophthalmology can be managed non-surgically, even if they have persisted for more than two months. These occur due to blockage of the oil glands in the eyelids, which need to open and allow the expression of oil contents to resolve.

Conservative management with the primary care team should include frequent application of warm compresses (7 minutes per application, 4 times per day). Often, a warm washcloth is insufficient to apply the needed therapeutic dose of heat to the lesion. Instead, patients with a stye or chalazia should use re-usable warming masks (such as Therapearls or Bruder mask), available at the pharmacy or grocery store. In the acute phase of these lesions, treatment with a topical antibiotic ointment can be useful. Oral antibiotics are only necessary in cases of overlying preseptal cellulitis.

If the lesion is recalcitrant to this conservative management, a non-urgent referral to ophthalmology is appropriate.

Referral guidance for strabismus

New esotropia and exotropia at any age warrants referral to ophthalmology within one to two weeks. Red flag signs include decreased vision, eye pain, double vision and specific limitation of gaze in one or both eyes (abduction deficit, upgaze deficit, etc.). Refer to ophthalmology urgently if any of these symptoms are present.

Consider this guidance for timing your referral:

• For new vertical strabismus, refer to ophthalmology within one to two weeks.
• For longstanding intermittent exotropia, refer to ophthalmology within two to three months.
• For longstanding esotropia in an individual older than 8, refer to ophthalmology within two to three months.

Referral guidance for a failed vision screening

Modern photo screenings are useful to identify refractive error. If your photo screener suggests that a child has an uncorrected refractive error, the fastest way for that patient to get evaluated for glasses is via a referral to a community optometrist. Here at Children’s Hospital Colorado, we are happy to evaluate these patients, though the wait times may be longer for these individuals.

If a child younger than 8 fails a vision screening, an eye care provider evaluation is more critical, as these patients are at risk of developing amblyopia. An eye care provider should evaluate these patients within three to four months.

If a child older than 8 fails a vision screening, they should be evaluated by an eye care provider within four to six months.

If the vision screening suggests other red flags, like strabismus or red reflex problems, please refer to our ophthalmology service accordingly.

Referral guidance for anisocoria

Refer to ophthalmology urgently for new onset anisocoria.

Ophthalmology professional resources 

Charting Pediatrics is a weekly podcast for pediatric healthcare providers. In this series, specialists from Children's Colorado examine the latest treatments for the most common complaints in pediatric medicine. Listen and subscribe on Spotify and Apple Podcasts.

Conjunctivitis: Should I Prescribe Medication for This? 

In this episode, Nicole Poole, MD, joins to discuss conjunctivitis treatment and the role pediatricians play in antibiotic stewardship.

The Eyes Have It: Emergency Eye Care in Pediatrics 

Pediatricians play a critical role in treating eye injuries and preventing subsequent visual loss. In this episode, Emily McCourt, MD, discusses recommendations on how to diagnose, triage and treat emergent eye injuries.

Most Common Eye Problems in Children 

In this episode, Emily McCourt, MD, discusses common eye problems in children and how to screen for eye disease.