Annex 4 Urgency of referrals table

	Emergency (ASAP)	Emergency (within 24 hrs)	Urgent / Priority – suggested telephone eye department for triage
	Condition
Anterior	Red eye (non traumatic) AACG Painful recent (<2/12) post-op (hypopyon / blebitis / endophthalmitis) Corneal graft rejection. Red eye (traumatic) – if severe Chemical burns (irrigate first) Penetrating injuries.	Red eye (non traumatic) Scleritis Infective keratitis Herpes zoster ophthalmicus with acute skin lesions (emergency referral to GP for systemic anti-viral treatment with urgent referral to ophthalmology if deeper cornea involved) Iritis / Uveitis Corneal melt. Red eye (traumatic) Hyphaema Corneal FB embedded into stroma or with rust ring (unless optom specifically trained in rust ring removal) Corneal or lid laceration. Other Acute dacryocystitis in children, or in adults if severe Viral conjunctivitis if severe (e.g. presence of pseudomembrane) Blunt trauma Hypopyon.	Iris rubeosis Chronic exophthalmos / proptosis Marginal keratitis Severe corneal abrasion Acute dacryoadenitis Acute dacryocystitis if mild Atopic keratoconjunctivitis with corneal epithelial macro-erosion or plaque Chlamydial conjunctivitis (refer to GP) Herpes zoster ophthalmicus if deeper cornea involved Corneal hydrops if vascularisation present. Keratoconjunctivitis sicca if Stevens-Johnson syndrome or ocular cicatrical pemphigoid are suspected. Ocular rosacea with severe keratitis Squamous cell carcinoma Vernal keratoconjunctivitis with active limbal or corneal involvement.
Visual loss	Suspected temporal arteritis Sudden complete loss of vision <6hrs.	Sudden visual loss of unknown cause (< 24 hrs)	Amaurosis fugax: refer to GP for TIA work-up Optic neuritis Sudden change in vision <2/52.
Posterior	Retinal artery occlusion <12hrs Retinal detachment: Macula on.	Floaters/photopsia < 48 hrs + tobacco dust Symptomatic retinal tears & breaks Retinal detachment: Macula off Pre-retinal haemorrhage (although a pre-retinal haem in a diabetic px with known proliferative retinopathy who is being actively treated in the HES would not need an emergency referral) Papilloedema CMV and candida retinitis.	Vitritis Vitreous haemorrhage Wet AMD (according to local protocol) CRVO with elevated IOP (=/>40mmHg refer as emergency) Myopic CNV BRVO + central foveal haem Proliferative diabetic retinopathy Commotio retinae Retinal detachment if not an emergency unless longstanding and asymptomatic Central serous retinopathy.
Other	Severe eye pain with nausea / vomiting.	Orbital cellulitis Acute proptosis Acute onset diplopia / squint / ptosis / nerve palsy (new, sudden or worse) Painful Horner’s syndrome Pain on ocular movement IOP ≥40mmHg (independent of cause) Sudden severe ocular pain, or post op <2/52.	Suspected cancers Suspected compressive lesion New pupillary defects IOP >35mmHg Steroid induced glaucoma.