2.2.6 Makes an appropriate judgement regarding referral and understands referral pathways

Emergency referrals

• Phone first to confirm the patient’s emergency appointment

• Give a letter to the patient to take with them

• Always send a copy to the GP so it can be added to the patients medical history

• A patient must always be consent to being referred

Emergency ASAP

• Acute angle closure glaucoma

• Endophthalmitis

• Corneal graft rejection

• Chemical injury

• Penetrating injuries

• Suspected giant cell arteritis

• Retinal artery occlusion

• Retinal detachment (macula-on)

• Severe eye pain with nausea / vomiting

Emergency within 24 hours

• Scleritis

• Infective keratitis

• Herpes zoster ophthalmicus with acute skin lesions

• Iritis / uveitis

• Hyphema

• Corneal foreign body embedded in stroma

• Corneal or lid laceration

• Acute dacryocystitis

• Viral conjunctivitis

• Hypopyon

• Sudden vision loss of unknown cause

• Floaters + tobacco dust

• Retinal detachment (macula-off)

• Pre-retinal haemorrhage

• Papilloedema

• CMV

• Orbital cellulitis

• Acute proptosis

• Acute onset diplopia / nerve palsy

• Painful Horner’s syndrome

• Pain on ocular movement

• IOP ≥ 40 mmHg

• Sudden ocular pain or post-op within 2 weeks (2/52)

Urgent but suggested phone eye department

• Iris rubeosis

• Chronic proptosis

• Marginal keratitis

• Severe corneal abrasion

• Acute mild dacryocystitis

• Chlamydial conjunctivitis (GP)

• Ocular rosacea with severe keratitis

• Squamous cell carcinoma

• Amaurosis fugax (GP)

• Optic neuritis

• Vitritis

• Vitreous haemorrhage

• Wet AMD

• CRVO

• BRVO + central foveal haemorrhage

• Myopic CNV

• Proliferative diabetic retinopathy (untreated)

• Central serous retinopathy

• New pupillary defects

• IOP >35 mmHg

• Steroid-induced glaucoma

Essentials to include in a referral

• Practice name / address

• Patient details

• Main reason for referral

• Urgency

• Which eye is affected

• Provisional diagnosis

• Evidence / clinical findings

• Additional imaging / tests

• Your name and qualifications

• GOC number

Common conditions and what to include:

• Glaucoma: IOP, field plots, ONH description, Van Herick, CCT, gonioscopy, refraction, VA

• Cataracts: VA, refraction, lens description, visual symptoms, other ocular conditions

• Diabetes: Refraction, VA, previous refraction and VA, Amsler chart, fundus assessment, IOP

• AMD: Wet / dry, onset, refraction, VA, pinhole, Amsler chart, fundus assessment

• Sudden-onset diplopia: Classification, refraction, VA, history, cover test, pupils, motility, field results, prisms required for BSV, general health