If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) 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