Start with acuity and VA
Document onset, laterality, baseline if known, and visual acuity for each eye when safe and available.
Ophtho consult triage
Should I Consult Ophthalmology?
A concise triage aid for vision loss, painful red eye, eye trauma, pressure concerns, corneal disease, and orbital symptoms.
Common presentations
Name the Eye Problem
Before you consult
Make the Eye Question Specific
Do the safe bedside exam
Include pupils/APD, lids/lashes/conjunctivae, fluorescein or Wood's lamp findings, and IOP only when open globe is not a concern and local practice supports it.
Know when to stop
If open globe, chemical exposure, orbital compartment concern, severe vision loss, or penetrating trauma is possible, use local emergency/Ophtho pathways instead of completing a checklist.
Ask a better question
Translate `red eye` into pain, photophobia, vision change, corneal findings, pupil/pressure concern, contact lens risk, trauma, surgery, or orbital signs.
Use this when the eye question involves acute vision change, painful red eye, trauma or open-globe concern, chemical exposure, corneal ulcer risk, pressure concern, postoperative symptoms, or orbital signs.
Common low-yield consults
Usually Better as Standard Care or Outpatient Eye Follow-Up
- Mild conjunctivitis pattern with preserved vision and no pain, photophobia, contact lens risk, trauma, or surgery context.
- Chronic stable blurry vision, cataract concern, or routine screening question without acute change.
- Stable subconjunctival hemorrhage without trauma, vision change, pain, or anticoagulation concern needing local pathway.
- Routine postoperative logistics without pain, decreased vision, severe redness, discharge, wound concern, or pressure symptoms.
Copyable consult message
Ophtho Consult Dotphrase
Reason for Consult: *** HPI: *** APD: *** Lids/lashes/conjunctivae: *** Visual Acuity: OD ***, OS *** Woods Lamp: *** IOP: *** Clinical question: *** Callback: *** Thank you!
Best practices for Ophtho consults
- Lead with acuity and visual acuity: new since when, OD/OS, and worse than baseline if known.
- Include APD, lids/lashes/conjunctivae, fluorescein/Wood's lamp findings, and IOP when safe and available.
- If open globe is possible, avoid pressure on the eye and do not obtain IOP just to complete the template.
- Translate `red eye` into pain, photophobia, vision change, corneal findings, pupil/pressure concern, contact lens risk, trauma, surgery, or orbital signs.
Ophtho exam guide
Dotphrase Terms and Bedside Exam Links
Acronyms
APD means afferent pupillary defect, also called RAPD when relative. OD is right eye, OS is left eye, and IOP is intraocular pressure.
Wood's lamp
Fluorescein is placed in the eye, the patient blinks, and blue/UV illumination is used to look for bright green epithelial defects, foreign-body patterns, or Seidel streaming. Slit lamp is preferred when available because Wood's lamp exams can miss corneal pathology.
IOP safety
If open globe or penetrating injury is possible, avoid pressure, patching, or IOP measurement. Shield the eye and use local emergency/Ophtho pathways.
Technique videos
Fluorescein staining video, EyeRounds exam video atlas, and Tono-Pen IOP video.
Complaint buckets
Name the Eye Problem Before the Call
Vision loss
Acute monocular loss, severe decrease, APD, field cut, curtain, flashes/floaters, eye pain, trauma, or recent procedure.
Painful red eye
More concerning when paired with decreased vision, severe pain, photophobia, corneal opacity, abnormal pupil, IOP concern, contact lenses, trauma, or surgery.
Trauma or foreign body
Mechanism matters: high velocity, metal/glass/organic material, penetrating injury, hyphema, abnormal pupil, orbital fracture, or canalicular/lid-margin injury.
Chemical exposure
Local emergency chemical-eye protocol generally comes first. Ophtho discussion can occur in parallel per local workflow; document pH, agent, timing, symptoms, and exam after initial actions.
Cornea / contact lens
Contact lens use plus pain, photophobia, staining, opacity, infiltrate, central lesion, or decreased vision is different from routine conjunctivitis.
Pain with eye movement, bulging eye, or double vision
Proptosis/bulging eye, pain with EOM, ophthalmoplegia, restricted EOM, APD, decreased vision, fever/sinus disease, or trauma can change service routing.
Ophtho consults FAQ
Common Ophtho Questions
What details help before Ophtho discussion?
Try to provide OD/OS visual acuity, pupils/APD, basic external and anterior exam, fluorescein findings when relevant, contact lens/trauma/surgery history, and IOP when available and safe.
Does every red eye need Ophtho?
No. Urgency is driven by vision change, pain or photophobia, corneal involvement, abnormal pupil or IOP concern, trauma, contact lens ulcer risk, recent surgery, herpes/keratitis concern, or orbital signs.
Can I wait for IOP before calling?
Not if the patient has a clear emergency pattern or your local workflow prioritizes immediate Ophtho/ED escalation. If open globe is possible, avoid pressure on the eye.
Who else may need to be involved?
Depending on the presentation: trauma/OMFS for facial injury, ENT for sinus or orbital cellulitis source, neurology/stroke pathway for neuro-visual symptoms, Rheum/medicine for GCA/systemic disease, or burn/ICU/poison control pathways for severe chemical injuries.
References
- [1] AAFP diagnosis and management of red eye in primary care.
- [2] AAFP eye emergencies and evaluation of the painful eye.
- [3] AAO EyeWiki pre-ophthalmologist management of eye trauma, penetrating/perforating injuries, and acute ocular trauma evaluation.
- [4] Merck Manual Professional Edition globe injury and corneal abrasions and foreign bodies.
- [5] StatPearls tonometry and StatPearls applanation tonometry.
- [6] ALiEM Wood's lamp and ocular exam limitations.
- [7] University of Iowa EyeRounds videos: fluorescein staining, clinical ophthalmology video atlas, and Tono-Pen IOP measurement.
- [8] WikEM: red eye by symptoms, acute vision loss, caustic keratoconjunctivitis, corneal ulcer, and orbital cellulitis.
Educational tool only. SIC provides clinician-facing educational consult-triage references. SIC does not diagnose, treat, prevent, cure, or mitigate disease and is not a substitute for clinical judgment, local guidelines, institutional referral pathways, or recommendations from your ophthalmology department. See disclaimer and how SIC works.