REFERRAL GUIDELINES FOR OCULAR PATHOLOGY TO MREH EMERGENCY EYE DEPARTMENT (EED) Emergency Emergency Urgent/Priority Routine As soon as possible Within 24 hours May wait overnight/weekend GOS 18 or appropriate direct referral pathway Telephone EED 7 Days 8am-8pm Conditions Red eye (non traumatic) Red eye (non traumatic) ● Iris rubeosis ● Symptomatic entropion/ectropion ● Acute Angle Closure ● Scleritis ● Chronic Exophthalmos/proptosis ● Persistent lid disease/cysts/hordeolum Glaucoma ● Infective keratitis ● Repeatable IOP >32mmHg ● Longstanding ptosis ● Painful recent post- ● Herpetic infection: ● Marginal keratitis ● Severe dry eye op/hypopyon/blebitis simplex & zoster ● Severe corneal abrasion ● Pterygium (affecting visual axis) ● Corneal graft rejection ● Iritis/Uveitis ● Acute dacryocystitis ● Persistent epiphora ● Keratoconus Anterior Red eye (traumatic) Red eye (traumatic) ● Recurrent corneal erosion syndrome ● Chemical burns- irrigate & ● Hyphaema ● Corneal dystrophy (reduced VA) refer asap ● Embedded foreign body ● Allergic conjunctivitis ● Penetrating injuries ● Naso-lacrimal duct obstruction ● Cataract REFER VIA DIRECT REFERRAL PATHWAY ● IOP >21mmHg <32mmHg REFER TO GRRS OPTOM if GP in Manchester area (GOS 18 if not) ● Possible Temporal ● Sudden visual loss ● Amaurosis fugax: refer to GP for TIA ● Gradual loss of VA >4weeks with no sudden loss Visual Arteritis unknown cause (<24hrs) work-up Loss with visual symptoms ● Optic neuritis ● Retinal artery occlusion ● Floaters/photopsia <48 ● Vitritis ● Retinal haemorrhages <24hours hours + tobacco dust ● Vitreous haemorrhage ● Branch retinal vein occlusion refer within ● Retinal detachment: ● Retinal tears & breaks ● Wet AMD ● Central Serous Retinopathy 4 weeks : if via the macular on ● Papilloedema ● CRVO REFER TO EMERGENCY GP you must check the referral is processed Myopic CNV MACULA CLINIC (EMAC) ● Suspect glaucoma/abnormal discs REFER TO GRRS ● BRVO + central URGENTLY OPTOM if GP in Manchester area (GOS 18 if not) Posterior foveal haem ● Dry AMD requiring registration/LVA  Diabetic proliferative retinopathy REFER ● Retinitis Pigmentosa VIA DIABETIC EYE SCREENING ● Macular hole PROGRAMME or telephone ARC if ● Epiretinal membrane outside DRSS ● Diabetic maculopathy REFER VIA DIABETIC EYE SCREENING PROGRAMME (GOS 18 if outside DRSS) ● Orbital cellulitis ● Suspected retinal cancers ● Repeatable suspicious field defects ● Acute proptosis ● Suspected compressive lesion ● Long standing squint requiring correction Other ● Acute onset diplopia/ ● New pupillary defects ● Childrens manifest squint, amblyopia/reduced VA squint/ptosis/nerve palsy REFER VIA DIRECT ORTHOPTIC PATHWAY

Making referrals Telephone EED on 0161 276 5597/5599 (8am-8pm every day incl bank Contact EED on 0161 276 5597/5599 8am-8pm Use GOS18 or equivalent via the GP holidays). WRITE A REFERRAL LETTER FOR THE PATIENT TO BRING WITH Contact Diabetic Eye Screening on 0161 206 3838 Send Orthoptic referrals on GOS18 or equivalent to THEM. Contact EMAC CLINIC on 0161 701 3419 or community orthoptic clinic or contact orthoptic head office FAX 0161 7010262 on 0161 248 1207

This list is not exhaustive. Practitioners should always apply their clinical judgement when deciding on the appropriate clinical pathway. Vs6 updated 18th may 2016