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Ophthalmology referral guidelines, including Out of Hours (Guidelines)

Audience

  • Highland Health and Social Care Partnership
  • Primary and Secondary Care

Introduction

WEEKDAYS 09:00 to 17:00 hours (but excluding Public Holidays) phone Eye Clinic on 01463 709111 or 0800 111 4526. Senior Ophthalmology Nurses will triage the referral and offer a suitable appointment or provide management advice. If given an appointment email the completed Ophthalmology Referral Form to:  nhsh.eyecasualtyntch@nhs.scot

OUT OF HOURS - from 08:00 to 09:00 and 17:00 to 20:00 on weekdays (16.00 to 20.00 on Fridays) or 08:00 to 20:00 Saturday and Sunday (plus Public Holidays)- discuss very urgent cases with the on-call Ophthalmologist. 

OVERNIGHT (20:00 to 08:00) follow the Ophthalmology Emergency Protocols

If patients don’t require admission but do need to be seen urgently by Ophthalmology the following morning, (e.g Angle closure glaucoma, definite Retinal detachment):

  • Complete the Ophthalmology Referral Form
  • E-mail completed Referral along with copy of clinical notes to nhsh.eyecasualtyntch@nhs.scot(flag as “URGENT” in email SUBJECT HEADING)
  • Give paper copy of referral to patient too
  • Keep copy of Ophthalmology Referral Form with Clinical Notes
  • Ask the patient to attend the Eye Clinic at the National Treatment Centre-Highland (NOT Raigmore Hospital) at 09.00 (weekdays) or 10.00 (Sat/Sun).

For cases that need soon Ophthalmology involvement (but not out of hours), ie. most cases use e-mail referral as above and the Ophthalmology triage nurses will contact the patient the following day to arrange review.

Ophthalmology Referral form

Click here for the referral form

Printable Visual Acuity Chart (and instructions)

SNELLEN EYESIGHT CHART (3M, A4)

The below chart should be printed onto A4 paper.

Instructions:

  • Use with patient’s distance (“driving” or “TV”) glasses
  • Hold chart 3 metres from patient
  • Ensure chart well lit
  • Test each eye individually

Please click here to view and print the Snellen Chart.

Ophthalmology Emergencies OOH: Peripheral Hospitals

  • Endophthalmitis – immediate transfer to National Treatment Centre
  • Orbital Cellulitis – D/W Raigmore ENT On-call
  • Angle Closure Glaucoma/Ocular penetration/Retinal detachment/Chemical injury/Lid trauma – Admit to peripheral hospital, follow Ophthalmology Emergency Protocols overnight then send patient with Ophthalmology referral form first thing (to arrive at NTC Eye Clinic 09.00 if possible)
  • Suspected Temporal Arteritis with visual loss – Admit to peripheral hospital, follow Ophthalmology Emergency Protocols overnight and D/W On call Ophthalmologist following morning

 

Ophthalmology Emergencies OOH: GPs

Management will depend whether GP is seeing patient in a peripheral hospital or in the community AND distance from Raigmore:

  1. If patient being seen in a peripheral hospital OR being seen in the community a long distance from Raigmore but close to a peripheral unit, follow Peripheral Hospital advice above
  2. If patient being seen closer to Raigmore, admit to Raigmore Hospital or NTC Ophthalmology as appropriate [consider initiating treatment for suspected Temporal Arteritis (steroid), Angle Closure Glaucoma (Acetazolamide) or Orbital Cellulitis (antibiotic) if likelihood of delay in transfer]

Last reviewed: 28/03/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 2

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Thorfinn Leslie, Consultant Ophthalmologist.

Document Id: TAM429

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