What are the indications for referring a patient for corneal transplant evaluation in primary care?

In primary care, patients should be referred for corneal transplant evaluation when they present with significant corneal pathology causing visual impairment that is not amenable to medical or less invasive surgical treatments. Key indications include:

• Advanced corneal scarring or opacification resulting in substantial vision loss.
• Corneal dystrophies or degenerations leading to progressive visual decline.
• Non-healing corneal ulcers or perforations where medical management has failed.
• Severe corneal edema unresponsive to medical therapy.
• Corneal thinning disorders with risk of perforation.

Referral should be considered when these conditions significantly impact the patient’s quality of life or daily functioning, and when specialist assessment is needed to determine suitability for transplantation. Early referral is important to optimise outcomes, as delays can lead to irreversible vision loss. While UK guidelines primarily focus on cataracts and glaucoma management ¹, the literature on corneal surgery highlights that corneal transplantation is indicated in cases where structural corneal integrity or transparency is compromised beyond conservative management (Telle and Betbeze, 2022). Thus, primary care clinicians should identify patients with persistent or progressive corneal disease unresponsive to standard treatments and refer them promptly for specialist evaluation (Telle and Betbeze, 2022)¹.