What criteria should I use to determine whether a patient with keratitis requires referral to an ophthalmologist?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025Updated: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

A patient with keratitis requires urgent referral to an ophthalmologist if they present with specific clinical features ,.

  • Severe disease, which includes significant keratitis or corneal ulceration ,.
  • Corneal involvement associated with soft contact lens use ,. If topical fluorescein reveals corneal staining (epithelial defect) in a contact lens wearer, urgent referral is required as this can be a sight-threatening condition . Bacterial keratitis can also occur in contact lens wearers .
  • Contact lens-related red eye, which should be referred for same-day assessment or within 24 hours .

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