Urgent advice line: 01708 435 000 Ext. 6662

Please fill in the urgent eye care referral form [docx] 17KB and email it to bhrut.urgenteyecare@nhs.net

This list is intended to be guidance about which conditions require emergency or urgent referral.

Emergency referral (within 24 hours), symptoms or signs suggesting:

• Acute glaucoma
• Acute dacryocystitis in children, or in adults if severe
• Cellulitis (preseptal or orbital)
• Corneal foreign body penetrated into stroma, or with presence of a rust ring (unless optometrist is specifically trained in rust ring removal)
• CRAO
• Endophthalmitis
• Facial palsy, if new or with loss of corneal sensation
• 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)
• Hyphaema
• Hypopyon
• IOP>/40mmHg (independent of cause)
• Microbial keratitis
• Orbital cellulitis
• Papilloedema
• Penetrating injuries
• Pre-retinal haemorrhage, although a pre-retinal haemorrhage in a diabetic patient with known proliferative retinopathy who is already being actively treated in the HES would not need an emergency referral
• Retinal detachment unless this is long-standing and asymptomatic
• Scleritis
• Sudden severe ocular pain
• Suspected temporal arteritis
• Symptomatic retinal breaks and tears
• Third nerve palsy with pain
• Trauma (blunt or chemical), if severe
• Unexplained sudden loss of vision
• Uveitis
• Vitreous detachment symptoms with pigment in the vitreous
• Viral conjunctivitis if severe (e.g. presence of pseudomembrane)

Urgent referral (within one week):

• Acute dacryocystitis, if mild
• Acute dacroadenitis
• Atopic keratoconjunctivitis with corneal epithelial macro-erosion or plaque
• Chlamydial conjunctivitis (refer to GP)
• CMV and candida retinitis
• Commotio retinae
• Corneal hydrops if vascularisation present
• CRVO with elevated IOP (40mmHg refer as emergency)
• Herpes zoster ophthalmicus with deeper corneal involvement – urgent referral to ophthalmology, but refer to GP as an emergency for systemic anti-viral treatment
• IOP>35 mm Hg (and <40mmHg) with visual field loss
• Keratoconjunctivitis sicca if Stevens-Johnson syndrome or ocular cicatricial pemphigoid are suspected
• Retinal detachment if not an emergency, see above
• Retrobulbar/optic neuritis
• Ocular rosacea with severe keratitis
• Rubeosis
• Squamous cell carcinoma
• Steroid induced glaucoma
• Sudden onset diplopia
• Unilateral blepharitis, if carcinoma suspected
• Vernal keratoconjunctivitis with active limbal or corneal involvement
• 'Wet’ macular degeneration/choroidal neovascular membrane, according to local fast-track protocol.