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