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

A patient with keratitis requires urgent referral to an ophthalmologist if they present with specific clinical features ¹,².

• Severe disease, which includes significant keratitis or corneal ulceration ¹,².
• Corneal involvement associated with soft contact lens use ¹,². 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 ². Bacterial keratitis can also occur in contact lens wearers ².
• Contact lens-related red eye, which should be referred for same-day assessment ³ or within 24 hours ³.