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 3^rd 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