Urgent Eye Referral Guidance |
| Publication: 24/09/2014 |
| Next review: 01/04/2024 |
| Referral Guideline/Pathway |
| CURRENT |
| ID: 3960 |
| Approved By: Trust Clinical Guidelines Group |
| Copyright© Leeds Teaching Hospitals NHS Trust 2021 |
This Referral Guideline/Pathway is intended for use by healthcare professionals within Leeds unless otherwise stated. |
Urgent Eye Referral Guidance
Aims
Background
Diagnosis
Investigation
Pertinent aspects of history and examination - Key diagnostic criteria
Aims
To improve the referral of urgent eye conditions to Ophthalmology
Background
There has been a recent Serious Untoward Incident in LTHT resulting in preventable sight loss. The Risk Management Team and the Eye Dept have developed this guidance to help non ophthalmic staff to be more aware of what needs referring, especially the urgent eye conditions.
Diagnosis
History: Sudden onset of visual loss (with or without pupil involvement), distortion in vision and pain should be referred urgently.
Examination: All patients should have Snellen Visual Acuity recorded and pupil check.
Investigation
For suspected Giant Cell/Temporal Arteritis, all patients should have a plasma viscosity/ESR and C-Reactive Protein (CRP) blood test.
Pertinent aspects of history and examination - Key diagnostic criteria
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URGENT |
RAPID |
STANDARD |
CLINIC REFERRAL |
|
VISION |
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Duration of visual loss |
Visual loss <12 hrs |
Visual loss 12hrs- 48 hrs |
Visual loss < 4 weeks |
>4 weeks |
|
Type of visual loss |
Complete |
Marked- Moderate blurring |
Mild |
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Associated pain/headache |
++ |
+ |
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New Visual Distortion |
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|
+ |
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New Flashes/ New floaters |
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+ |
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Curtain like visual loss |
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+ |
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Diplopia ( Double vision) |
Painful |
Sudden onset |
< 2/52 duration |
>2/52 duration |
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PAINFUL EYE |
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Scoring |
8-10 |
6-8 |
<5 |
No pain |
|
Relief with analgesia |
No |
No |
Yes |
|
|
Keeping awake at night |
Yes |
Yes |
No |
|
|
Associated nausea/ vomiting |
Yes |
Yes |
No |
|
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Associated photophobia |
Yes |
Yes |
No |
|
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RED EYE |
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Loss of vision |
Yes |
Yes |
No |
No |
|
Pain |
Yes |
Yes |
No |
No |
|
Discharge |
+/- |
+/- |
Yes |
occasional |
|
Nausea /Vomiting |
Yes |
No |
No |
No |
|
Itchy eye |
|
|
|
Yes |
|
Contact lens (CL) wearer |
|
Yes |
|
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TRAUMA |
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Penetrating Trauma |
Yes |
|
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|
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Blunt trauma with blurred vision |
|
Yes |
|
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|
Blunt trauma with normal vision |
|
|
Yes |
|
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Hyphema (blood in the anterior chamber) |
|
Yes |
|
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Lid ecchymosis |
|
|
Yes |
|
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Chemical Injury |
Yes |
|
|
|
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Lid laceration |
|
Yes |
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HEADACHE |
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Visual loss |
|
Yes |
|
|
|
Temple tenderness |
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Yes |
|
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Directly Refer to Neurologist/ Physician headache without visual loss/ +- Temple tenderness |
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OPTOM REFERRAL |
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Lids |
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New ptosis with double vision |
Swollen lids+/- discharge with reduced vision |
Swollen lids with normal vision |
Epiphora |
|
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|
Herpes Zoster Ophthamicus with eye involvement |
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Blepharitis/Dry eye |
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New facial Nerve palsy with incomplete lid closure |
New facial Nerve palsy with good lid closure |
Painless Lumps / lid cyst |
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Conjunctiva |
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Red+++ |
Redness around the limbus |
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Cornea |
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Corneal ulcer |
Marginal ulcer |
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Sclera |
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Episcleritis /Scleritis |
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Pupil |
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Abnormal pupil with visual symptoms |
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Abnormal pupil size( No ptosis, No visual problem) |
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Iris |
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Recurrent Iritis |
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Retina/vitreous |
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Hypopyon (pus in the anterior chamber)/ Endophthalmitis |
Retinal tear |
New flashes/floaters |
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|
|
Acute Retinal Artery Occlusion |
Retinal detachment |
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|
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Neurophthalmology |
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New visual field defect |
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Repeatable suspicious visual field defect |
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Papilloedema/ Optic Disc Swelling |
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Suspected Giant cell Arteritis (GCA) with visual loss. |
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Directly Refer to Neurologist/ Physician for Retinal/ other transient ischaemic attack (TIA), Suspected GCA without visual loss |
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Trauma |
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Penetrating Eye injury |
Hyphema (blood in the anterior chamber) |
Corneal Foreign body |
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|
|
Chemical injury |
Acute proptosis |
Non healing Corneal Abrasion |
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Others |
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IOP> 40 mmHg |
IOP 30-39 mmHg |
|
IOP <30mm Hg |
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EXISTING EYE DEPARTMENT PATIENTS |
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Postoperative intraocular surgery/ post intravitreal injection < 2/52 with red eye+/- pain+/ -reduced vision+/- discharge |
Corneal graft with hazy vision/ red eye |
Diabetic Retinopathy with sudden visual loss |
|
|
|
|
Recurrent Iritis |
Known AMD patient with new distortion |
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|
|
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Recurrent Herpes Simplex Keratitis |
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| |
Provenance
| Record: | 3960 |
| Objective: |
|
| Clinical condition: | Urgent Eye Conditions |
| Target patient group: | All inpatients in LTHT |
| Target professional group(s): | Secondary Care Doctors Allied Health Professionals Secondary Care Nurses |
| Adapted from: |
Evidence base
References and Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)
Approved By
Trust Clinical Guidelines Group
Document history
LHP version 1.0
Related information
Equity and Diversity
The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.