New York State Medical Treatment Guidelines for Eye Disorders in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer general principles for addressing disorders related to the eyes. These directives aim to assist healthcare professionals in determining appropriate strategies for diagnosing and managing various eye-related conditions as part of a comprehensive care plan.

Healthcare practitioners specializing in eye disorders can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for assessing and treating conditions affecting the eyes in their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the management of eye disorders should involve collaboration between the patient and their healthcare provider.


Introduction to Eye Disorders

The medical treatment guideline for Eye Disorders is crafted to offer healthcare providers evidence-based guidance on treating working-age adults with potential work-related eye issues, spanning acute, subacute, chronic, or postoperative conditions. Although the primary focus is on working-age adults, the principles outlined may have broader applications. The guideline covers the initial assessment and diagnosis of patients with work-related eye injuries and disorders, including the identification of red flags signaling serious underlying medical conditions. It also addresses initial management, diagnostic considerations, special studies for clinical pathology and work-relatedness, modified duty, return-to-work strategies, and additional management considerations, such as for delayed recovery.

It’s important to note that this guideline excludes certain eye disorder categories like congenital disorders or malignancies, and it doesn’t delve into specific intraoperative procedures. For patients dealing with both allergies and work-related asthma, the Occupational/Work-Related Asthma Guideline is recommended, offering insights into exposure management for sensitizer-induced asthma, irritant-induced asthma, and criteria for removal from exposure.

This guideline aims to achieve several objectives, encompassing baseline evaluations, diagnostic tests, imaging, return-to-work strategies, medication recommendations, patching, injections, and operative procedures. Wherever possible, comparative effectiveness is considered. In an effort to be comprehensive, this guideline covers some disorders that may or may not be deemed work-related. However, it deliberately excludes disorders that are generally considered entirely nonoccupational.

For those interested in a more in-depth understanding of the guideline development process, a detailed methodology document is accessible online. This document outlines the methodology used for guideline development, including the selection and scoring of evidence, incorporation of cost considerations, and the formulation of recommendations. Additionally, a summarized version of this methodology document is available elsewhere for quick reference.

This guideline addresses health questions related to acute, subacute, chronic, and postoperative eye disorders, specifically focusing on the following aspects:

Diagnostic Studies:
– What diagnostic studies have been employed for pre/placement examinations?
– How effective are screening examinations?

Initial Assessment and Diagnostic Approach:
– What evidence supports the initial assessment and diagnostic approach?

Identification of Serious Conditions:
– What red flags indicate the presence of serious underlying condition(s)?

Diagnostic Approaches and Special Studies:
– What diagnostic approaches and special studies are effective in identifying clinical pathology?

Initial Treatment Approaches:
What initial treatment approaches have evidence of efficacy?

What is the evidence of work-relatedness for various diagnoses? (When appropriate)

When is patching appropriate?

Modified Duty:
What modified duty limitations are effective and recommended?

Return to Work:
When is return to work recommended?

Alternative Interventions:
When initial treatment options fail, what evidence supports other interventions?

Injections and Invasive Procedures:
When and for what conditions are injections and other invasive procedures recommended?

When and for what conditions is surgery recommended?
Which surgeries are recommended for which conditions?

By addressing these questions, the guideline aims to provide comprehensive insights into the assessment, diagnosis, and management of acute, subacute, chronic, and postoperative eye disorders.



This guideline employs classifications based on commonly accepted durations, categorizing conditions as acute (<1 month), subacute (1 to 3 months), and chronic (>3 months) where applicable. These temporal distinctions help in framing recommendations and treatment approaches according to the varying durations of eye disorders.


Risk and Causation

The causes of most ocular injuries are generally clear-cut. The eye is richly supplied with nociceptors, leading to acute and noticeable symptoms when an injury occurs. In contrast, ocular diseases pose more complexity, as various factors contribute to conditions like pterygia and cataracts. The development of ocular diseases tends to be influenced by a multitude of factors, making their origins and progression more intricate than acute injuries.


General Approach and Principles

The primary recommendations for assessing and treating patients with eye symptoms are outlined as follows:

  • Initial Assessment:
    • The initial assessment should primarily focus on identifying red flags, which are indicators of potentially serious injury or disease. Urgent assessment and treatment are necessary when red flags are detected.
  • Treatment Focus:
    • Treatment for patients with eye symptoms should prioritize optimal medical care, monitoring for potential complications, supporting the healing process, facilitating the ability to stay at work or encouraging an early return to work in either a modified or full-duty capacity. Surgical interventions should be considered when deemed necessary.
  • Return to Work:
    • Patients recovering from eye problems are generally encouraged to stay at work or consider an early return to modified work, based on their condition.
  • Occupational Factors:
    • Occupational factors should be taken into account, particularly when the disorder is believed to be caused by work.
  • Prevention Measures:
    • In cases where the injury or disorder is preventable, preventive measures should be addressed and implemented.

This guideline encompasses a range of eye injuries and disorders that health care providers may encounter.

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