What are the key signs and symptoms that indicate a need for urgent referral to ophthalmology in a patient with suspected acute glaucoma?

Key signs and symptoms indicating a need for urgent referral to ophthalmology in suspected acute glaucoma include:

• Sudden onset of severe eye pain.
• Marked reduction in vision or visual impairment that cannot be corrected with glasses.
• Red eye with a cloudy or hazy cornea.
• Nausea and vomiting associated with eye symptoms.
• Raised intraocular pressure (IOP), typically significantly above 24 mmHg, measured by Goldmann-type applanation tonometry.
• Signs of angle-closure on gonioscopy or peripheral anterior chamber depth assessment.

These features suggest an acute angle-closure glaucoma attack, which is an ophthalmic emergency requiring immediate specialist assessment and treatment to prevent permanent sight loss.