Symptom	Details	Examination	Possible diagnosis	Urgency of referral
Sudden Vision Loss/change	Curtain/shadow across vision	Red reflex	Retinal Detachment	Same day
	Painless sudden blackout	Funduscopy – hemorrhages	Retinal vessel (artery or vein) occlusion	Same day
	Floaters + flashes	Otherwise normal	PVD/retinal tear	Within the week, warn of progressing symptoms
	Field defect	Funduscopy – hemorrhages	Retinal vessel (artery or vein) occlusion	Same day
	Field defect	Otherwise normal Check pupils	Consider optic neuropathy or stroke	Same day

Symptom	Details	Examination	Possible diagnosis	Urgency of referral
Gradual Vision Loss	Glare worse at night	Red reflex	cataract	Routine if ADLs ok (3-6 months)
	Slow progressive central	Funduscopy – hemorrhages Red reflex	Early AMD cataract	Routine if ADLs ok (3-6 months)
	Hx of Diabetes	Funduscopy – hemorrhages	Diabetic retinopathy/maculopathy	Semi urgent (2-4 weeks)
	Field defect	Funduscopy – optic nerve	Glaucoma	Semi urgent (2-4 weeks)

Symptom

Details

Examination

Possible diagnosis

Urgency of referral

Central Visual Distortion

Wavy or distortion

Funduscopy – macula

Amsler

Wet AMD

Within the week

Other macula pathology

Within the week

Symptom

Details

Examination

Possible diagnosis

Urgency of referral

Fluctuating vision

Improve with blinking

Otherwise normal

Dry eye disease

Routine (3-6 months)

Symptom	Details	Examination	Possible diagnosis	Urgency of referral
Painful Blurry Vision	Red, painful eye	Corneal clear; Tearing/Discharge ++	conjunctivitis	Conservative treatment consider referring if not improving after a week
	Red, painful eye	Cornea cloudy/lesion	Cornea ulcer	Same day
	Red, painful eye, halos, nausea	Cloudy cornea	Acute angle closure glaucoma	Same day

Symptom	Details	Examination	Possible diagnosis	Urgency of referral
Visual Field Defect	Altitudinal or segmental loss	Check pupils	Ischemic optic neuropathy	Same day
	Hemianopia with neuro signs	Check neuro signs	Stroke/TIA	Medical work up/consider medical emergency first
	Progressive peripheral loss	Funduscopy -optic nerve	glaucoma	Semi urgent (2-4 weeks)

GP Tool kit

Funduscopy – check nerve, macula, peripheral (in order of difficulty)

Amsler – check if grid lines are straight or wavy, check one eye at a time

Check pupils – relative afferent pupillary defect (swinging light test)

Red reflex – look from half an arms length away, look for reduction in reflex compared to other eye

Visual acuity – simple Snellen chart on the back of a door