EYE EMERGENCY DEPARTMENT TRIAGE TOOL

This triage tool is to be used when triaging telephone referrals and e-referrals.
It is a guide and should be used as such.
If in doubt please discuss with a senior clinician.
Generally, any patient with symptoms present for more than 2 weeks should see their own optician/GP and/or be referred to outpatient clinic.

Prepared by Rynn Lee, agreed by Consultant body March 2020

Presentation Same session/ASAP Same day Within 24 hours Within 3 days Not appropriate – to see optician/GP
or referral to clinic
Trauma  Chemical injury  Blunt trauma  Blunt  Arc eye - advise
 Penetrating eye  Lid Laceration trauma>1/52<2/52 –
injury good VA and no pain
 Corneal abrasions
 Corneal FBs
Vision  Sudden  Sudden loss of  Sudden loss of vision  Sudden change in  Asymptomatic retinal pathology
complete loss of vision >6 hrs <12 >12 hours but <1/52 vision <2/52  Known AMD/CMO/DMO/RVO –
vision <6 hours hours  F&F with risk factors  F&F <2/52 or >2/52 email referral to macular clinic*
 Post op <2/52 loss (myope/tear/RD/FH if prev risk factors  F&F >2/52 PVD clinic (no previous
of vision of RD)  Visual distortion risk factors)
 Unilateral VF defect  Post op <2/52 <2/52  Gradual LOV >2/52
(new/following blurred vision  Mild blurring  Macular hole/ERMS/VMT
F&F)  Bilat visual disturbance <2hrs +/-
 Diplopia headache – GP/ED
(new/sudden  Irritation with discharge/gritty – see
onset) GP
 FB sensation – no history of FB see
GP
 Watery eyes – see GP
 Cataracts
Eye pain  4-5 score, no  3-4 score  Relief with analgesia,  In-growing lashes
Scale 1-5 relief from  Keeping patient photophobia
analgesia awake at night  Post op <2/52
 With nausea and  FB sensation <2/52
vomiting

Prepared by Rynn Lee, agreed by Consultant body March 2020

Presentation Same session/ASAP Same day Within 24 hours Within 3 days Not appropriate – to see optician/GP
or referral to clinic
Headache  4-5 score with  Painful scalp,  No eye symptoms – see
eye symptoms painful temples, GP/ED/Rheum
jaw pain (all with
eye symptoms)
 With diplopia
Lids/facial  New droopy  Swollen lids (normal  Puffy lids & red eye  Chalazion – advise warm compress,
lid/ptosis vision, apyrexial) <2/52, normal see GP
 Acute swollen lids  Proptosis (with visual vision  Blepharitis – lid hygiene, see
(with loss/pain)  Watery <2/52 GP/refer to clinic
fever/diplopia)  Itching <2/52  Proptosis only – GP 2 week referral
 Herpes Zoster – GP to start oral
antiviral asap and see within 24
hours

Cornea/  Cloudy, Red  Hazy, Red  Clear cornea, red  Red mild  Subconj hge – see GP/BP check
Conjunctiva severe (with moderate around limbus  >2/52 red eyes – see GP
pain)  CL wear  CL wear  incidental corneal/conj findings by
(redness/pain with (redness/pain OO – refer to OPD
reduced vision) without reduced  suspicion of keratoconus – refer to
 Corneal graft vision) OPD
patients – reduced  Corneal graft patients
vision, pain – FB sensation, no
LOV
 Redness and pain
with prev HSK,HZK,
immunosuppressed

Presentation Same session/ASAP Same day Within 24 hours Within 3 days Not appropriate – to see optician/GP

Prepared by Rynn Lee, agreed by Consultant body March 2020

 or referral to clinic
Glaucoma  Fixed, dilated  IOP40mmHg  IOP35<40mmHg  IOP<35mmHg – to refer to clinic
pupil with high  IOP21mmHg with  Post op – discuss with glaucoma
IOP nausea/reduced team urgently
 Nausea/vomiting vision  Drop allergy – discuss with
glaucoma team for which patient is
under
 Run out of drops – GP to prescribe

Paediatric  Unwell, pyrexial,  Swollen lids – not  Abnormal  >1/12 symptoms – see GP/refer to
swollen lids (see unwell, apyrexial pupil/unequal pupil OPD
once stable – with visual symptoms  Absent red reflex – GP to refer to
advise to attend OPD
ED)
Post-op  Moderate pain,  Post op <2/52 loss  Asymptomatic – OPD
LOV of vision  Post op <12/12 – refer to
 Profuse bleeding Consultant secretary
 hypopyon  Post op >12/12 – refer to OPD
 Post op drops – Consultant’s
secretary
Neuro  Unequal pupil  Swollen disc(s)  Bell’s palsy with  Unequal pupil size with no LOV, no
with ptosis,  New onset vision loss/pain ptosis, no trauma- GP to refer to
diplopia anisocoria clinic
 New onset diplopia  Bilat VF defect – ED/stroke team
 Bell’s Palsy without vision loss/pain
– advise lubricants and lip taping
 Diplopia with facial weakness –
GP/ED
Presentation Same session/ASAP Same day Within 24 hours Within 3 days Not appropriate – to see optician/GP
or referral to clinic

Prepared by Rynn Lee, agreed by Consultant body March 2020

Other  Acutely unwell  Hypheaema  Localised redness  Symptoms >2/52 see OO/GP to
adult with ocular (not subconj hge) refer to OPD
symptoms, <2/52
swollen lids,
pyrexia
 hypopyon

*Macular Clinic Uhcw.wetamd@nhs.net

Abbreviation

AMD Age related macular degeneration

CL Contact lens
CMO Cystoid macular oedema (swelling at macula due to inflammation/diabetes/vein occlusion etc)
DMO Diabetic macular oedema (swelling at macula due to diabetes)
ERM Epiretinal membrane
F&F Flashes and Floaters (flashes of light and black spots/cobweb in vision – usually unilateral)
FB Foreign body
FH Family history
HSK Herpes simplex keratitis
HZK Herpes zoster keratitis
LOV Loss of vision
OO Optician
OPD Outpatient department
PVD Posterior vitreous detachment
RD Retinal detachment
RVO Retinal vein occlusion
VF Visual field
VMT Vitreomacular traction

Prepared by Rynn Lee, agreed by Consultant body March 2020