Clinical Decision Making

2) Clinical Decision Making in Ocular Conditions Requiring Urgent Referral

 

2.1 It is suggested that the following conditions require emergency or urgent referral. This is for guidance only; there may be guidelines issued by your local ophthalmic unit. The list below is not intended to be exhaustive

 

(a) Emergency (same day) referral

                    

Acute glaucoma                                      CRAO<12 hours old

 

Corneal foreign bodies                            Pulsating proptosis

 

Hypopion                                                   Papilloedema

 

Pre-retinal haemorrhage                         Retinal Detachment

 

Sudden severe ocular pain                      Unexplained sudden loss of vision

 

Uveitis                                                        Chemical injuries

 

Hyphaema                                                  Orbital cellulitis

 

Penetrating injuries                                   Retinal breaks and tears

 

Sight threatening keratitis                         Suspected temporal arteritis

                

Vitreous Haemorrhage                               3rd Nerve Palsy

 

Vitreous detachment symptoms with pigment in the vitreous.

 

 

(b) Urgent referral


 

Basal cell carcinoma                             Central serous retinopathy

 

CMV and Candida retinitis                     Commotio retinae

 

CRVO with elevated IOP                        Dacryoadenitis

 

Dacryocystitis                                        Diabetic maculopathy (to screening)

 

Disc haemorrhage                                  Entropion

 

Scleritis                                                   Sudden onset diplopia

 

IOP > 35 mmHg                                      Keratitis

 

Macular hole < 6 – 12 months old          Pre proliferative diabetic retinopathy

 

Proliferative diabetic retinopathy           Retrobulbar/optic neuritis

 

Rubeosis                                                   Squamous cell carcinoma

 

Wet macular degeneration*                                                                                        

*Special arrangements for referral of wet AMD are in place see section on wet AMD