The College of Optometrists

Annex 4 Urgency of referrals table

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 Emergency (ASAP)Emergency (within 24 hrs)Urgent / Priority – suggested telephone eye department for triage
  Condition
Anterior

Red eye (non traumatic)

  • AACG
  • Painful recent (<2/12) post-op (hypopyon / blebitis / endophthalmitis)
  • Corneal graft rejection.

Red eye (traumatic) – if severe

  • Chemical burns (irrigate first)
  • Penetrating injuries.

Red eye (non traumatic)

  • Scleritis
  • Infective keratitis
  • Herpes zoster ophthalmicus with acute skin lesions (emergency referral to GP for systemic anti-viral treatment with urgent referral to ophthalmology if deeper cornea involved)
  • Iritis / Uveitis
  • Corneal melt.

Red eye (traumatic)

  • Hyphaema
  • Corneal FB embedded into stroma or with rust ring (unless optom specifically trained in rust ring removal)
  • Corneal or lid laceration.

Other

  • Acute dacryocystitis in children, or in adults if severe
  • Viral conjunctivitis if severe (e.g. presence of pseudomembrane)
  • Blunt trauma
  • Hypopyon.
  • Iris rubeosis
  • Chronic exophthalmos / proptosis
  • Marginal keratitis
  • Severe corneal abrasion
  • Acute dacryoadenitis
  • Acute dacryocystitis if mild
  • Atopic keratoconjunctivitis with corneal epithelial macro-erosion or plaque
  • Chlamydial conjunctivitis (refer to GP)
  • Herpes zoster ophthalmicus if deeper cornea involved
  • Corneal hydrops if vascularisation present.
  • Keratoconjunctivitis sicca if Stevens-Johnson syndrome or ocular cicatrical pemphigoid are suspected.
  • Ocular rosacea with severe keratitis
  • Squamous cell carcinoma
  • Vernal keratoconjunctivitis with active limbal or corneal involvement.
Visual loss
  • Suspected temporal arteritis
  • Sudden complete loss of vision <6hrs.
  • Sudden visual loss of unknown cause (< 24 hrs)
  • Amaurosis fugax: refer to GP for TIA work-up
  • Optic neuritis
  • Sudden change in vision <2/52.
Posterior
  • Retinal artery occlusion <12hrs
  • Retinal detachment: Macula on.

  • Floaters/photopsia < 48 hrs + tobacco dust
  • Symptomatic retinal tears & breaks
  • Retinal detachment: Macula off
  • Pre-retinal haemorrhage (although a pre-retinal haem in a diabetic px with known proliferative retinopathy who is being actively treated in the HES would not need an emergency referral)
  • Papilloedema
  • CMV and candida retinitis.
  • Vitritis
  • Vitreous haemorrhage
  • Wet AMD (according to local protocol)
  • CRVO with elevated IOP (=40mmHg refer as emergency)
  • Myopic CNV
  • BRVO + central foveal haem
  • Proliferative diabetic retinopathy
  • Commotio retinae
  • Retinal detachment if not an emergency unless longstanding and asymptomatic
  • Central serous retinopathy.
Other
  • Severe eye pain with nausea / vomiting.
  • Orbital cellulitis
  • Acute proptosis
  • Acute onset diplopia / squint / ptosis / nerve palsy (new, sudden or worse)
  • Painful Horner’s syndrome
  • Pain on ocular movement
  • IOP>=40mmHg (independent of cause)
  • Sudden severe ocular pain, or post op <2/52.
  • Suspected cancers
  • Suspected compressive lesion
  • New pupillary defects
  • IOP >35mmHg (and
  • Steroid induced glaucoma.

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