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

Summary of urgency referrals

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.

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