Doctors' area
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EyeTriage System
A traffic-light guide to how urgently to refer eye problems. Full guidance is coming soon.
No matches. Try another word, or discuss with on-call.
RedEmergency
See immediately / ASAP. Refer to the on-call ophthalmologist.
Acute angle closure glaucoma
- Severe eye pain and headache
- Nausea or vomiting
- Blurred vision with haloes around lights
- Red eye with hazy cornea
- Fixed mid-dilated pupil and rock-hard eye
Central retinal artery occlusion (CRAO)
- Sudden, painless, severe vision loss
- RAPD
- Pale, swollen retina
- Cherry-red spot at the macula
- Age over 50: ask about GCA symptoms and check ESR/CRP
Chemical injury
- Irrigate immediately before referral; check pH
- Alkali is worse than acid
- Severe pain and blepharospasm
- Epithelial defect on fluorescein
- Limbal blanching or corneal haze
Corneal ulcer (microbial keratitis)
- Contact lens wearer (common risk)
- Pain and photophobia
- Reduced vision
- White corneal infiltrate with an epithelial defect
- Hypopyon
Endophthalmitis
- Recent eye surgery, intravitreal injection or penetrating injury
- Increasing eye pain
- Worsening vision
- Hypopyon
- Poor red reflex and lid swelling
Globe rupture
- Significant blunt trauma with severe pain and vision loss
- 360° bullous subconjunctival haemorrhage
- Abnormally deep or shallow anterior chamber
- Soft eye: do not press on the globe; shield it
- Restricted eye movement or uveal prolapse
Optic neuritis
- Vision loss over hours to days
- Pain on eye movement
- RAPD
- Reduced colour vision (red desaturation)
- Central scotoma
Orbital cellulitis
- Painful or restricted eye movements
- Proptosis
- Reduced vision or colour vision
- RAPD
- Fever and unwell, with lid swelling and redness
Penetrating eye injury
- Sharp or high-velocity mechanism (e.g. hammering metal on metal)
- Reduced vision
- Irregular or peaked pupil
- Shallow anterior chamber or hyphaema
- Visible wound, uveal prolapse or positive Seidel test
Retinal detachment
- New flashes
- New floaters
- Curtain or shadow in the vision
- Reduced central vision if the macula is involved
- Tobacco dust (Shafer sign) or RAPD
Retrobulbar haemorrhage
- After trauma or periocular surgery or injection
- Sudden tense proptosis
- Reduced vision and RAPD
- Restricted eye movements and tense lids
- Raised IOP with severe pain: may need urgent lateral canthotomy
Scleritis
- Severe boring pain, often waking at night
- Tender globe
- Deep violaceous (bluish-red) redness
- Associated autoimmune disease (e.g. RA, GPA)
- Reduced vision
Traumatic foreign body
- High-velocity mechanism (hammering, grinding, drilling): suspect intraocular foreign body
- Embedded or deep corneal foreign body, or one in the visual axis
- Reduced vision
- Irregular pupil, hyphaema or positive Seidel test
- Do not remove a penetrating object; shield the eye. Request orbital X-ray or CT (no MRI if metal suspected)
YellowUrgent
See within 24 to 48 hours. Refer to on-call, or advise the patient to attend a Community Eye Clinic.
Anterior uveitis
- Eye ache and photophobia
- Ciliary (circumcorneal) injection
- Small or irregular pupil
- Blurred vision
- Previous episodes or HLA-B27-related disease
Corneal abrasion
- History of scratch or trauma
- Pain, tearing and foreign body sensation
- Photophobia
- Epithelial defect on fluorescein; evert lids for a foreign body
- Contact lens wearer: think microbial keratitis (RED)
Dacryocystitis
- Painful, red, tender swelling at the inner corner of the eye (over the lacrimal sac)
- Watery eye, often long-standing
- Pus expressed from the punctum on pressing the sac
- Fever or unwell
- Spreading lid swelling, proptosis or reduced eye movement: treat as orbital cellulitis (RED)
Herpes zoster ophthalmicus (HZO)
- Vesicular rash in the V1 dermatome
- Hutchinson sign (rash on the tip of the nose)
- Red eye
- Photophobia or reduced vision (keratitis or uveitis)
- Start oral antivirals early (ideally within 72 hours)
Periorbital (preseptal) cellulitis
- Lid swelling and redness
- Normal vision
- Full, painless eye movements
- No proptosis
- Any of these abnormal: treat as orbital cellulitis (RED)
Thyroid eye disease
- Proptosis
- Lid retraction or lid lag
- Gritty, red eyes
- Double vision
- Reduced vision or colour vision, or RAPD: treat as RED
Vitreous haemorrhage
- Sudden floaters or haze
- Reduced vision
- Poor red reflex
- Diabetic or trauma history
- Needs ultrasound to exclude retinal detachment
GreenNon-urgent
No need to discuss with on-call. Non-urgent referral, or advise the patient to attend a Community Eye Clinic.
Blepharitis
- Gritty, burning, itchy eyes, both sides
- Red, crusty lid margins
- Flakes or crusting on the lashes in the morning
- Blocked meibomian glands; often with dry eye
- Long-term: lid hygiene and warm compresses
Cataract
- Gradual, painless blurring of vision
- Glare, especially at night
- Frequent changes in glasses
- Reduced red reflex or visible lens opacity
- Normal pupil reactions
Chalazion and stye (hordeolum)
- Lump in the eyelid
- Stye: painful, red, pointing at the lash line
- Chalazion: firm, painless lump within the lid
- Normal vision and eye movements
- Spreading lid redness and swelling: think preseptal cellulitis (YELLOW)
Pinguecula
- Yellowish raised spot on the conjunctiva beside the cornea (usually nasal)
- Does not grow onto the cornea (unlike pterygium)
- Mild irritation or dryness
- Occasionally inflamed and red (pingueculitis)
- Normal vision
Pterygium
- Fleshy, wing-shaped growth from the conjunctiva onto the cornea (usually nasal)
- Redness and irritation
- Foreign body sensation
- Cosmetic concern
- Reduced vision if it approaches the visual axis
Refractive error
- Gradual, painless blurred vision
- Improves when looking through a pinhole
- Headaches or eye strain with reading or screens
- Squinting to see clearly
- Children: check vision at school screening; adults over 40: reading difficulty (presbyopia)
Subconjunctival haemorrhage
- Bright red patch on the white of the eye with clear edges
- Painless, with normal vision
- Often after coughing, straining or minor rubbing
- Check BP; ask about anticoagulants; recurrent: check clotting
- After significant trauma, or 360° and bullous: think globe rupture (RED)
Brief draft guide. Five key symptoms and signs per condition. Use clinical judgement and local protocols; if unsure, discuss with on-call.
Ophthalmology training
Resources for ophthalmology training in Brunei.
The EyeGuideA quick clinical reference for eye doctors.Coming soon
The Phaco Nucleus TrainerPractise nucleus management for phacoemulsification.Open
Brunei Ophthalmology Basic Specialist TrainingThe training programme's site.Open Eye research
Updated every morning. External links open in a new tab.
🌍 New eye research
The latest studies from leading ophthalmology journals: Ophthalmology, JAMA Ophthalmology, BJO and AJO.
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🇧🇳 Brunei eye research
Eye articles from the Brunei International Medical Journal.
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