Referral for ophthalmology opinion

In general, red eyes presenting in primary care, are most often secondary to conjunctivits (infective or allergic). If there are any features suggestive of either iritis, acute glaucoma, a foreign body or any other significant cause of a red eye then immediate ophthalmological review is required.

Examples of when ophthalmological review is required include:

• if there is impairment of visual acuity, or,
• if there are abnormal pupillary reactions, or,
• if conjunctival injection is most marked around the pupil (suggestive of keratitis, corneal ulcer or intraocular pathology), or,
• if there is corneal ulceration, or,
• if there is a history of possible penetrating injury, or,
• if fundus is cloudy, or,
• if there is associated significant pain rather than the 'gritty' discomfort associated with conjunctivitis, or,
• if topical treatment for presumed conjunctivitis has not led to improvement