What are the indications for referring a patient with a corneal abrasion to an ophthalmologist?

Refer a patient with a corneal abrasion to an ophthalmologist if any of the following indications are present:

• Significant reduction in visual acuity or defects in the visual axis accompanied by corneal oedema.
• Worsening vision or symptoms such as pain, photophobia, foreign body sensation, or redness that are not improving.
• Increase in size of the abrasion or presence of a corneal infiltrate, ulcer, or infection.
• Presence of a rust ring after removal of a metallic foreign body, which requires removal by ophthalmology within 1-2 days.
• Suspected penetrating eye injury or intraocular foreign body, especially from high-velocity or sharp object injuries.
• Significant orbital or peri-ocular trauma.
• Chemical injury requiring immediate copious irrigation and emergency referral.
• Retained foreign body that cannot be safely removed in primary care or foreign bodies composed of organic material.
• Foreign bodies in or near the centre of the cornea due to risk of permanent visual loss.
• Severe pain, irregular/dilated/non-reactive pupils, hyphema or hypopyon, large or deep abrasions, corneal opacity, or suspected infection/corneal ulcer.
• Inability to tolerate examination or foreign body removal in primary care.
• Contact lens wearers with corneal abrasion, as they are at risk of sight-threatening infections and should not be started on antibiotics in primary care.
• Abrasion not improving or worsening 24 hours after treatment initiation.
• Recurrent erosion syndrome or superficial corneal injury associated with contact lens use.

These referral criteria are based on clinical guidelines and expert opinion to prevent complications and preserve vision.

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