When should I consider referring a patient with optic neuritis to a neurologist or ophthalmologist?

Consider referring a patient with optic neuritis to a neurologist or ophthalmologist if there is:

• Significant reduction in vision or acute onset sight loss, as this requires urgent ophthalmology assessment to prevent permanent damage.
• Severe eye pain accompanying vision changes, which necessitates same-day ophthalmology referral.
• Suspicion of underlying neurological conditions such as multiple sclerosis, which often requires neurologist involvement for diagnosis and management.
• Diagnostic uncertainty or need for specialized assessment including slit-lamp examination and visual field testing, which are beyond primary care capabilities.
• Signs of complications or atypical presentations such as raised intraocular pressure or other ocular abnormalities.

Early referral is important because optic neuritis can be a presenting feature of serious neurological disease and requires specialist evaluation to guide treatment and prognosis.

In summary, urgent referral to an ophthalmologist is indicated for acute vision loss or severe pain, while referral to a neurologist is appropriate when there is suspicion of demyelinating disease or other neurological involvement.