If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
NB - in an emergency of any of the following, its advised to arrange immediate transfer to the emergency department.
Adult
Retinal artery occulsion
- Patients with central or branch retinal artery occlusion
Glaucoma
- Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
- Angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, ‘rainbows’ around lights, or sluggish pupil reactions)
- Patients with IOP >35mmHg
Adult/paediatric strabismus
- Sudden onset of any of the following:
- constant convergent squint (esotropia) or
- divergent squint (exotropia) or
- double vision at any age
Other referrals to emergency
- Sudden severe visual loss e.g. macular or vitreous haemorrhage, retinal detachment or retinal artery occlusion
- Rubeosis iridis (iris new vessels)
- Corneal graft rejection
- Contact lens keratitis, corneal ulcers
- Uveitis/scleritis
- Intra ocular pressure (IOP) > 35 mmHg
- Signs and/or symptoms of retinal detachment
- Acute injury e.g. trauma, burns, chemical exposure, foreign body
- Acutely inflamed eye
- Preseptal/orbital cellulitis - worsening eyelid oedema, erythema and proptosis
- Ocular signs or symptoms of temporal arteritis
- Ophthalmology conditions associated with sudden onset neurological signs and/or symptoms e.g. third cranial nerve palsy or optic disc swelling
Paediatric
Leukocoria
- White red reflex (refer directly by telephone to the on-call ophthalmology registrar)
Anisocoria (unequal pupil size)
- If acute onset and associated with neurological signs
Chalazion/meibomian cyst
- Chalazion with an abscess
Reduced visual acuity
- Sudden severe vision loss in a child
Elevated optic nerve head
- If neurological anomaly signs (vomiting, abnormal pupils, severe headache)
- If Retinal haemorrhages or exudates
