Table 2

Summary of recommendations on urgent care for ophthalmologists during the COVID-19 pandemic per international ophthalmology society

SocietyExamples of urgent treatments
  • Glaucoma (acute, uncontrolled or rapidly progressive).

  • Wet active age-related macular degeneration.

  • Sight threatening treatable retinovascular disease.

  • Acute retinal detachments.

  • Severe active uveitis.

  • Ocular and adnexal oncology – active, aggressive, uncontrolled or untreated lesions.

  • Retinopathy of prematurity.

  • Endophthalmitis.

  • Sight-threatening trauma.

  • Sight-threatening orbital disease (orbital cellulitis and severe thyroid eye disease).

  • Giant cell arteritis affecting vision.

  • Acute chemical injury or acute Stevens Johnson syndrome.

  • Acute lens complications.

  • Appositional choroidal effusion, suprachoroidal haemorrhage or flat anterior chamber.

  • Bleb leaks, wound leaks, overfiltration, underfiltration, bleb scarring or shallow anterior chamber.

  • Complications with implanted devices in the cornea or anterior segment.

  • Congenital cataract in the amblyopic period, monocular patients with documented vision loss precluding driving, reading or self-care, lens-induced glaucoma, angle-closure glaucoma, acute lens complications or severe anisometropia of fellow eye post recent lens extraction in first eye.

  • Dacryocystocele.

  • Displaced facial bone fractures.

  • Endophthalmitis, corneal touch, corneal decompensation or exposed plate.

  • Glaucoma when uncontrolled or absolute with a blind and painful eye, or when catastrophic or rapidly progressive.

  • Haemodynamic instability or oculocardiac reflex.

  • Impending corneal compromise.

  • Implant/tube exposure that might be sight threatening, endophthalmitis, malpositioned tube endangering eye or excessive inflammation, a tube that might worsen vision due to corneal oedema or iritis or cystoid macular oedema or with a severe tube malposition causing rapid visual loss.

  • Injury or trauma to the canaliculus, cornea or sclera.

  • Intraocular malignancy.

  • Lacerations of eyelid or face.

  • Lacerations, blunt rupture or deeply embedded corneal foreign body.

  • Lens-induced glaucoma or angle-closure glaucoma.

  • Life-threatening or sight-threatening conditions (ie, congenital ptosis, hypotony due to trauma, infection, intractable pain, hyphaemia, progressive vision loss, uncontrolled intraocular pressure, suspected tumour or malignancy).

  • Neonate with obstructive respiratory compromise.

  • Ocular trauma, infection, intractable glaucoma, globe perforation, intractable pain or intraocular malignancy.

  • Orbital cellulitis.

  • Orbital tumour with impending vision loss.

  • Pain due to ocular diseases causing significant compromise of quality of life.

  • Paediatric patients with: retinoblastoma, endophthalmitis, Coats disease, uveitis, glaucoma, ocular trauma, retinal detachment, presumed intraocular foreign body, corneal blindness in both eyes in their amblyopic period or retinopathy of prematurity.

  • Presumed intraocular foreign body.

  • Proliferative diabetic retinopathy, proliferative vitreoretinopathy, complex preretinal membrane or complex macular pathology.

  • Retinal detachment, ocular trauma, intraocular infection, vitreous haemorrhage, retinal tear, intraocular foreign body, misdirected aqueous, ciliary block glaucoma, malignant glaucoma, a vitreous prolapse or a tube shunt that blocks filtration.

  • Suspected giant cell arteritis.

  • Torn or lost extraocular muscle.

  • Wound dehiscence or other wounds, including dislocated LASIK flaps.1

  • Macula-threatening retinal detachment.

  • Postoperative hypotony.7

Referral to AAO recommendations for exhaustive list.1
SEOMore than 60 examples of urgent cases inspired from the Moorfields Eye Hospital National Health Service Foundation Trust and more than 40 urgent procedures inspired from the American Academy of Ophthalmology.9
  • Wound of the globe with or without an intraocular foreign body.

  • Retinal detachments of less than 1 month’s duration.

  • Retained lens material.

  • Acute endophthalmitis with decreased vision.

  • Removal of non-absorbable synthetic implants resistant to antibiotic treatment.10

DOGReferral to AAO website and other resources.8
  • Acute glaucoma patients.12

  • Diseases leading to blindness or complications: retinal detachment, bulging cataracts and retinopathy of prematurity.

  • Malignant tumours: retinoblastoma, malignant melanoma, squamous cell carcinoma and orbital tumour.

  • Ocular trauma: corneal perforation, conjunctival laceration, ocular rupture, orbital fracture, intraocular foreign body, intraocular foreign body, corneal foreign body, corneal foreign body and traumatic flap detachment after LASIK surgery.

  • Infectious diseases: postoperative intraocular inflammation, eyelid abscess, lacrimal sac inflammation and intraocular inflammation associated with filtration vesicle infection.

  • Glaucoma: paediatric glaucoma, rapidly progressing glaucoma and lens-derived glaucoma.

  • Other: corneal transplants, congenital cataracts requiring amblyopia treatment, traumatic cataracts, important ophthalmic surgery and intravitreal injections.13

  • Chemical injuries.

  • Blunt trauma or perforating injuries.

  • Open globe injuries with or without foreign body.

  • Lid trauma.

  • Angle closure glaucoma.

  • Neovascular glaucoma.

  • Elevated intraocular pressure >38 mm Hg.

  • History of recent onset sudden vision loss (<2 weeks) – central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), vitreous hemorhage (VH), retinal detachment.

  • Retinal tears.

  • Endophthalmis.

  • Expulsive choroidal haemorrhage.

  • Exposed infected buckle.

  • Orbital cases with vision loss.

  • Severe inflammation – lid/orbit.

  • Tumour cases with vision loss.

  • Corneal abrasion/superficial foreign body (including contact lens lost in eye)/ulcer.

  • Postoperative follow-up.

  • Patients requiring intravitreal injections with fresh bleed or those requiring for endophthalmitis.

  • One eyed patients on anti-vascular endothelial growth factor (VEGF) with sudden loss of vision.14

OSSANo examples provided.
IRSONo COVID-19 information available.
CHOSNo COVID-19 information available.