When to refer to ophthalmology: urgent, soon or routine
- Topic
Referral speed depends on how fast sight can be lost: minutes, the same day, within a week or routinely. This page groups the common cases.
What it is
Most eye complaints can be handled in primary care, but some must reach an ophthalmologist quickly. The urgency depends on how fast sight is lost if treatment is delayed. Grouping problems by time to referral helps primary care doctors decide, write a clear referral and tell the patient what to do if things worsen.
Referral urgency for common eye problems
| Urgency | Examples |
|---|---|
| Treat now, then emergency referral | Chemical burn, orbital compartment syndrome |
| Emergency (within hours) | Central retinal artery occlusion, open globe, acute angle closure, endophthalmitis, giant cell arteritis with visual loss, orbital cellulitis |
| Same day | Sudden visual loss, retinal detachment, keratitis or contact lens red eye, anterior uveitis, hyphema, neonatal conjunctivitis, pupil-involving third nerve palsy |
| Within a week | New floaters without red flags, new distortion over 50, leukocoria (within days), severe or proliferative diabetic retinopathy |
| Priority (weeks) | Suspected glaucoma, macular oedema, childhood strabismus or amblyopia, thyroid eye disease without optic neuropathy |
| Routine | Cataract affecting daily life, refraction, stable chronic conditions, chalazion not resolving |
In clinical practice
- A good referral states visual acuity of each eye, the time of onset, the main findings and what was already done.
- If the urgency is unclear, a phone call to the ophthalmologist on duty is better than a routine letter.
- Tell patients which symptoms mean they must come back at once.
Next step / Initial management
- Record visual acuity in every referral.
- Telephone for emergencies and same-day cases; do not rely on a written referral alone.
- Start first treatment where indicated (irrigation, canthotomy, pressure-lowering drugs, corticosteroids for arteritis) before transfer.
- Give written return advice for routine referrals.
Test yourself
Think of the answer, then tap the question to see it.
Which eye problems are treated by the first doctor before an emergency referral?
A chemical burn (irrigation) and an orbital compartment syndrome (lateral canthotomy).
Which piece of information must every eye referral include?
The visual acuity of each eye.
How urgent is a suspected retinal detachment?
Same day; an emergency if central vision is still good.
Connections
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Pautas para la valoración de la salud visual para profesionales de medicina y enfermería, en el marco de la Resolución 3280 de 2018 (Ministerio de Salud y Protección Social de Colombia, 2019); Central Retinal Artery Occlusion (StatPearls Publishing (NCBI Bookshelf), 2024); Ocular Burns (StatPearls Publishing (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.