Ophthalmology

We are based in the Borders Eye Centre at the Borders General Hospital

General Ophthalmology - All Ophthalmology referrals are assessed in the Borders Eye Centre or peripheral clinics. Surgery is carried out at the BGH. A few surgical cases, e.g. for vitreo-retinal surgery, are referred from the BGH elsewhere.
Orthoptics and Low Vision Aids - Orthoptic clinics are held at the BGH and other sites. The Low Vision Aid clinic is held at the BGH. These services are provided by the orthoptists.
Care of the visually impaired is carried out by the Sensory Services team.
There are several nurse-led services: triage of emergency referrals, pre and post-operative assessments, stable glaucoma clinics and macular fast track clinics with oct and angiography.

Who to refer, who not to refer, how to refer

How to Refer Patients – Emergency, Urgent and Routine

Emergency

To be seen in

< 72 hours

Urgent

To be seen within

4 weeks

Routine

referrals

Information/advice only, or requests to expedite existing referral

Telephone

SCI-gateway (Urgent)

SCI-gateway (Routine)

Emergency Contact Numbers (patients that need to be seen within 72 hours)

Borders Eye Centre sees patients by appointment only. Patients are referred and an appropriate appointment is booked or advice given over the phone. The clinic does not have the capacity to accept "walk-ins".

Monday to Thursday 08:30 until 16:30 01896 826759 (Borders Eye Centre)

Monday to Thursday 16:30 until 08:30 0131 536 1000 (Switchboard at the Royal Infirmary, ask for on call ophthalmologist)

Friday to Monday 08:30 until 08:30 0131 536 1000 (Switchboard at the Royal Infirmary, ask for on call ophthalmologist)

All referrals require details of an eye examination including intra-ocular pressure and relative afferent pupillary defect.

Ophthalmology presentations and suggested referral urgency guidance

The table below has been developed as a tool to assist with ophthalmology referrals. However, diagnoses are not absolute and if there are atypical features, please contact the emergency contact numbers above.

Condition	Route of referral	Additional Information
Painful red eye
Angle closure glaucoma	SCI-gateway (Routine)
Iritis	SCI-gateway (Routine)
Scleritis	SCI-gateway (Routine)	Consider oral NSAID
Episcleritis		Manage with topical lubricants and oral NSAIDs – refer if not settling
Keratitis – bacterial, HSV, marginal	SCI-gateway (Routine)
Corneal ulcer	SCI-gateway (Routine)
Recurrent erosion syndrome		Manage with topical lubricants. May need a course of chloramphenicol ointment to treat a flare-up. Refer if not settling
Trauma
Corneal foreign body		Send patient to A&E
Blunt trauma		Send patient to A&E
Penetrating eye injury/globe rupture		Send patient to A&E
Chemical injury		Immediate irrigation in primary care by GP/optometrist/A&E
Retro-orbital haemorrhage		Send patient to A&E
Eyelid laceration		Send patient to A&E
Corneal abrasion		Manage in primary care (chloramphenicol ointment QDS 1 week) Use of lubricants following the abrasion is important to prevent recurrent erosion syndrome
Welders flash		Consider optometrist management
Non-painful red eye
Subconjunctival haemorrhage		No need to refer. These can take a few weeks to resolve. Are they on warfarin/anticoagulants? BP?
Dry eye		Manage in primary care Regular lubricants
Conjunctivitis – viral, allergy, bacterial		Manage in primary care
Lid swelling/involvement
Pre-septal cellulitis	SCI-gateway (Routine)	Need not be referred Could be managed in community
Orbital cellulitis	SCI-gateway (Routine)	See section on orbital cellulitis
Dacrocystitis	SCI-gateway (Routine)	See section on dacrocystitis
Herpes Zoster Ophthalmicus	SCI-gateway (Routine)	Need not refer unless eye is involved (red, painful, decreased vision)
Ectropion, entropion	SCI-gateway (Routine)	Routine plastics clinic Refer if patients would consider surgical treatment
Suspected SCC/BCC	SCI–gateway (Urgent)
Chalazion/cyst	SCI-gateway (Routine)	Manage in primary care Need not be referred unless not resolving and patient would consider surgery Regular lid hygiene measures as initial management
Blepharitis		Manage in primary care Lid hygiene
Neuro- ophthalmology
Temporal arteritis	SCI-gateway (Routine)	Refer to ophthalmology only if visual symptoms are present otherwise referral is to Rheumatology Check ESR/CRP. Start oral prednisolone
Nerve palsy without red flags (see diplopia algorithm)	SCI-Gateway (Urgent)	See also diplopia
Optic neuritis	SCI-gateway (Routine)
Disc swelling/ suspected idiopathic intracranial hypertension	SCI-gateway (Routine)
Pre-existing/worsening adult squint	SCI-gateway (Routine)
Other Retinal pathology
Hypertensive retinopathy	SCI-Gateway (Urgent)	Please also refer to GP for measurement/management of blood pressure
Choroidal naevus	SCI-Gateway (Urgent)	Initially monitor by optometrist – only refer if suspicious features
Suspected melanoma	SCI-Gateway (Urgent)
Acute vision loss
Vein occlusion	SCI-Gateway (Urgent)	Please address cardiovascular risk factors
Artery occlusion	Phone call	Please address cardiovascular risk factors
Retinal detachment	Phone call
Wet AMD	SCI-Gateway (Urgent)
Macular haemorrhage	SCI-Gateway (Urgent)
Central serous retinopathy	SCI-Gateway (Routine)
Cystoid macular oedema	SCI-Gateway (Urgent)
Flashes floaters
Vitreous haemorrhage	Phone call	Please address diabetic control
Posterior vitreous detachment		Initial assessment by optometrist
Retinal tear/hole	Phone call
Gradual loss of vision
Cataract	SCI-Gateway (Routine)	Referral by optometrist only
Posterior capsular opacification	SCI-Gateway (Routine)
Dry AMD		Do not refer unless for low vision clinic or eligible for sight impairment registration
Diplopia		Please describe and highlight whether vertical/horizontal or monocular/binocular
Acute 3^rd Nerve Palsy		Urgent assessment in A&E
Acute 4^th or 6^th nerve palsy	Phone call
Acute painful diplopia of unknown cause	Phone call
Acute painless diplopia of unknown cause	SCI-Gateway (Urgent)	Consider referral to optometrist first
Chronic diplopia	SCI-Gateway (Routine)	Consider referral to optometrist first
Paediatrics
Cataract in a child		Refer to Paediatric Ophthalmology in Edinburgh
Suspected retinoblastoma		Refer to Paediatric Ophthalmology in Edinburgh
Neonatal conjunctivitis (within 28 days of birth)		Refer to Paediatric Ophthalmology in Edinburgh
Acute reduction in vision		Refer to Paediatric Ophthalmology in Edinburgh
Squint	SCI-Gateway (Urgent)	Please include which eye, constant/intermittent, duration and age of onset, past medical history
Intermittent visual loss
Ocular Migraine		Manage in primary care
Amaurosis fugax		Referral to neurovascular service
Diabetes
Proliferative retinopathy or maculopathy	SCI-Gateway (Urgent)	Manage diabetic control and risk factors
Glaucoma / Raised IOP
Acute angle closure	SCI-Gateway (Routine)
Painful with IOP > 35	SCI-Gateway (Routine)
Painless, IOP < 30	SCI-Gateway (Routine)
Painless, IOP > 30	SCI-Gateway (Urgent)
Post-operative
Infection – suspected endophthalmitis	SCI-Gateway (Routine)
Inflammation	SCI-Gateway (Urgent)
Thyroid Eye Disease
If optic nerve involvement or corneal exposure	SCI-Gateway (Urgent)	Endocrinology / GP to manage thyroid function
If no optic nerve involvement	SCI-Gateway (Routine)	Endocrinology / GP to manage thyroid function