Clinical decision-making in optometric referrals to the hospital eye service for managing the red eye relies on reasoning, judgement and deliberation. This process is guided by College of Optometrists guidelines, the principles of the General Optical Council and of course common sense.

It is recognised that inexperienced clinicians are characterised by marked but unfounded certainty about situations. As experience develops, increasing complexities of clinical presentations are gradually realised,  including the recognition of those scenarios when it is better not to intervene. To aid such judgements in our clinical practice, we often follow the ‘clues’ that the patient might share with us. This revealed overt and covert information leads us to descriptors including location, intensity and duration of symptoms. A hypothesis to explain the patient’s symptoms can then be derived, leading to further data collection by directed history and examination techniques. Furthermore, the fluency and speed at which seemingly complex decisions are made increase. This may be simplified by employing apparently tacit but effective strategies to help direct the consultation.