When to Refer: Eye Referral Urgency Guide for Optometrists
Last updated: October 2026
For optometrists, opticians and general practitioners: which eye findings need an ophthalmologist today, within a week, or routinely. When in doubt, phone first.
Emergency: same day (within hours)
| Finding | Suspect |
|---|---|
| Sudden painless loss of vision in one eye | Retinal artery or vein occlusion, retinal detachment, vitreous haemorrhage, ischaemic optic neuropathy |
| Sudden vision loss with headache, jaw pain or scalp tenderness in someone over 50 | Giant cell arteritis (start steroids, check ESR and CRP) |
| New flashes and floaters with a shadow or curtain in the field | Retinal tear or detachment |
| Painful red eye with blurred vision, haloes, nausea and a mid-dilated pupil | Acute angle closure |
| Chemical splash | Irrigate immediately for at least 15–30 minutes before transfer |
| Penetrating injury, irregular pupil, hyphaema, or a high-velocity foreign body | Open globe or intraocular foreign body (shield the eye, nothing by mouth) |
| Contact lens wearer with a painful red eye and a corneal infiltrate | Microbial keratitis |
| Red, painful eye after recent eye surgery or injection | Endophthalmitis |
| Swollen, red lids with painful or reduced eye movements, proptosis or fever | Orbital cellulitis |
| Bilateral swollen discs with headache | Raised intracranial pressure |
| New double vision with a dilated pupil or ptosis | Third nerve palsy (aneurysm until proven otherwise) |
| White pupil reflex in a child | Retinoblastoma (urgent, same week at the latest) |
Urgent: within 1 week
- IOP above 35 mmHg with an open angle, or IOP above 30 mmHg with disc or field damage
- Painful red eye without vision loss (iritis, scleritis, herpetic keratitis)
- Recent unexplained drop in vision, new distortion (possible wet AMD: ideally within days), or a new central scotoma
- Sudden onset of squint or double vision without the red flags above
- Suspicious pigmented fundus lesion with orange pigment, fluid or symptoms
- Proliferative or severe non-proliferative diabetic retinopathy, or diabetic macular oedema affecting the centre
- Possible papilloedema in a patient with no headache and normal vision (still needs same-week assessment)
Routine referral
- Cataract affecting daily life; suspected glaucoma with IOP under 30 mmHg; ocular hypertension; stable dry AMD
- Mild or moderate non-proliferative diabetic retinopathy without macular oedema (within the screening schedule)
- Chronic lid problems, pterygium, chalazion that does not resolve, stable long-standing squint, amblyopia in an older child
- Keratoconus suspects (send topography); children with high or rising myopia for myopia control
Include in the referral: visual acuity for each eye with correction, IOP and method, refraction, findings, field or OCT printouts, and how urgent you think it is. Tell the patient why they are being referred and how soon they must be seen.
Related: ophthalmic emergencies on call, screening schedules, eye injury (for patients).
Key sources
- The College of Optometrists (UK). Guidance for Professional Practice and Clinical Management Guidelines
- Royal College of Ophthalmologists. Ophthalmic Services Guidance: emergency eye care
- American Academy of Ophthalmology. Preferred Practice Patterns (various)
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