What are the referral criteria for a patient with unexplained eye movement abnormalities to a specialist?

Refer a patient with unexplained eye movement abnormalities for neurological assessment if the eye movements are involuntary and accompanied by additional progressive neurological symptoms or if they cause significant functional impairment. Specifically, adults with involuntary movements of the face, neck, limbs, or trunk that cannot be temporarily suppressed by mental concentration should be referred for neurological assessment or to neurology or an eye clinic if blepharospasm (involuntary tight eye closure of both eyes) is present or persists for more than 3 months. Do not routinely refer adults with isolated involuntary eyelid movements unless these cause blepharospasm or persist beyond 3 months. Sudden-onset involuntary movements such as chorea, ataxia, or dystonia in children require immediate referral. For adults, referral is indicated if the eye movement abnormalities are part of a broader pattern of neurological signs or progressive symptoms. Always consider local pathways for referral to neurology or specialist eye clinics depending on the presentation and severity of symptoms.