Consider referring a patient with keratoconus for corneal cross-linking or other surgical interventions when there is evidence of progressive corneal thinning and steepening that threatens vision, or when visual acuity deteriorates despite optimal correction with glasses or contact lenses. Referral should be made to an ophthalmologist experienced in corneal diseases for assessment and management options, including corneal cross-linking, intracorneal ring segments, or corneal transplantation if advanced disease is present.
Early referral is important to halt progression and preserve vision, especially in younger patients or those with rapidly progressing keratoconus. Surgical interventions are generally considered when non-surgical management fails to maintain adequate vision or when corneal scarring or ectasia worsens.