| ||Emergency (ASAP)||Emergency (within 24 hrs)||Urgent / Priority – suggested telephone eye department for triage|
Red eye (non traumatic)
- 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)
- 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)
- Corneal FB embedded into stroma or with rust ring (unless optom specifically trained in rust ring removal)
- Corneal or lid laceration.
- Acute dacryocystitis in children, or in adults if severe
- Viral conjunctivitis if severe (e.g. presence of pseudomembrane)
- Blunt trauma
- 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.
- 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.
- 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)
- CMV and candida retinitis.
- 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.
- 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.