Building and maintaining interprofessional collaborative practice in eyecare: Learnings from the Queensland Paediatric Optometry Alignment Program.

PURPOSE: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme. METHODS: Qualitative deductive and inductive content analysis was applied to open-ended free-text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM-B (Capability, Opportunity, Motivation-Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross-sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey. RESULTS: Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free-text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist. CONCLUSION: The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital-to-community care models.

Keeping an eye on congenital disorders of O-glycosylation: A systematic literature review.

Congenital disorders of glycosylation (CDG) are a rapidly growing family comprising >100 genetic diseases. Some 25 CDG are pure O-glycosylation defects. Even among this CDG subgroup, phenotypic diversity is broad, ranging from mild to severe poly-organ/system dysfunction. Ophthalmic manifestations are present in 60% of these CDG. The ophthalmic manifestations in N-glycosylation-deficient patients have been described elsewhere. The present review documents the spectrum and incidence of eye disorders in patients with pure O-glycosylation defects with the aim of assisting diagnosis and management and promoting research.

Retinopathy of prematurity: the high cost of screening regional and remote infants.

IMPORTANCE: Demand for retinopathy of prematurity (ROP) screening is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. BACKGROUND: The objective of this study is to evaluate the cost of ROP screening at a large centralized tertiary neonatal service for infants from regional/rural hospitals. DESIGN: This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28-month period. PARTICIPANTS: A total of 131 infants were included in this study. METHODS: Individual infant costs were calculated from analysis of clinical and administrative records. MAIN OUTCOME MEASURES: Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. RESULTS: The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669 413. The average cost per infant screened was highest for infants from a regional centre with a population of 75 000 (AUD$14 856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. CONCLUSIONS AND RELEVANCE: Health system costs for ROP screening of remote infants at a centralized hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening.

Dynamic, in vivo, real-time detection of retinal oxidative status in a model of elevated intraocular pressure using a novel, reversibly responsive, profluorescent nitroxide probe.

Changes to the redox status of biological systems have been implicated in the pathogenesis of a wide variety of disorders including cancer, Ischemia-reperfusion (I/R) injury and neurodegeneration. In times of metabolic stress e.g. ischaemia/reperfusion, reactive oxygen species (ROS) production overwhelms the intrinsic antioxidant capacity of the cell, damaging vital cellular components. The ability to quantify ROS changes in vivo, is therefore essential to understanding their biological role. Here we evaluate the suitability of a novel reversible profluorescent probe containing a redox-sensitive nitroxide moiety (methyl ester tetraethylrhodamine nitroxide, ME-TRN), as an in vivo, real-time reporter of retinal oxidative status. The reversible nature of the probe's response offers the unique advantage of being able to monitor redox changes in both oxidizing and reducing directions in real time. After intravitreal administration of the ME-TRN probe, we induced ROS production in rat retina using an established model of complete, acute retinal ischaemia followed by reperfusion. After restoration of blood flow, retinas were imaged using a Micron III rodent fundus fluorescence imaging system, to quantify the redox-response of the probe. Fluorescent intensity declined during the first 60 min of reperfusion. The ROS-induced change in probe fluorescence was ameliorated with the retinal antioxidant, lutein. Fluorescence intensity in non-Ischemia eyes did not change significantly. This new probe and imaging technology provide a reversible and real-time response to oxidative changes and may allow the in vivo testing of antioxidant therapies of potential benefit to a range of diseases linked to oxidative stress.

Prevalence and outcomes of laser treatment of aggressive posterior retinopathy of prematurity.

BACKGROUND: To describe outcomes in a cohort of extremely premature infants treated for aggressive posterior retinopathy of prematurity by diode laser panretinal photocoagulation. DESIGN: Retrospective study. PARTICIPANTS: Fifteen eyes in eight infants. METHODS: A review was carried out on infants between 23 and 25.6 weeks gestational age admitted to The Royal Brisbane and Women's Hospital neonatal intensive care unit between 1992 and 2009. MAIN OUTCOME MEASURES: Success of treatment, visual and refractive outcomes. RESULTS: Five hundred fifty-four infants were admitted to neonatal intensive care unit, 373 survived till screening, and 304 had retinopathy of prematurity. Sixty-six infants required treatment, and eight of these had aggressive posterior retinopathy of prematurity (2.5% of all infants with retinopathy of prematurity). Mean gestational age was 24.2 weeks, mean birthweight was 634 g, and treatment occurred at mean 34.1 weeks post-menstrual age. The mean total number of burns per eye was 2967. Five of 15 treated eyes required retreatment. Two patients subsequently died of unrelated causes. Regression occurred in 9 of 11 remaining eyes; one eye progressed to stage 4b and another to stage 5 retinopathy of prematurity. Vitrectomy was performed in two eyes. Five eyes had 6/12 vision, one had 3/60, and three had no perception of light. Of the remaining two eyes, one had good fixation and the other had poor fixation. CONCLUSIONS: Despite good structural outcomes, visual outcomes for conventional laser treatment of aggressive posterior retinopathy of prematurity are poor.

Assessment of neuroretinal function in a group of functional amblyopes with documented LGN deficits.

PURPOSE: In this study we examine neuroretinal function in five amblyopes, who had been shown in previous functional MRI (fMRI) studies to have compromised function of the lateral geniculate nucleus (LGN), to determine if the fMRI deficit in amblyopia may have its origin at the retinal level. METHODS: We used slow flash multifocal ERG (mfERG) and compared averaged five ring responses of the amblyopic and fellow eyes across a 35 deg field. Central responses were also assessed over a field which was about 6.3 deg in diameter. We measured central retinal thickness using optical coherence tomography. Central fields were measured using the MP1-Microperimeter which also assesses ocular fixation during perimetry. MfERG data were compared with fMRI results from a previous study. RESULTS: Amblyopic eyes had reduced response density amplitudes (first major negative to first positive (N1-P1) responses) for the central and paracentral retina (up to 18 deg diameter) but not for the mid-periphery (from 18 to 35 deg). Retinal thickness was within normal limits for all eyes, and not different between amblyopic and fellow eyes. Fixation was maintained within the central 4° more than 80% of the time by four of the five participants; fixation assessed using bivariate contour ellipse areas (BCEA) gave rankings similar to those of the MP-1 system. There was no significant relationship between BCEA and mfERG response for either amblyopic or fellow eye. There was no significant relationship between the central mfERG eye response difference and the selective blood oxygen level dependent (BOLD) LGN eye response difference previously seen in these participants. CONCLUSIONS: Retinal responses in amblyopes can be reduced within the central field without an obvious anatomical basis. Additionally, this retinal deficit may not be the reason why the LGN BOLD (blood oxygen level dependent) responses are reduced for amblyopic eye stimulation.

Treatment of retinopathy of prematurity in extremely premature infants over an 18-year period.

BACKGROUND: To report the efficacy of laser diode therapy in the treatment of retinopathy of prematurity (ROP) in extremely premature (EP) infants over an 18-year period. DESIGN: Retrospective study. PARTICIPANTS: One hundred twenty-eight eyes in 66 infants treated between 23 and 25.6 weeks. METHODS: Five hundred fifty-four infants between 23 and 25.6 weeks gestational age (GA) were admitted to The Royal Brisbane and Women's Hospital Neonatal Intensive Care Unit (NICU) between 1992 and 2009. Three hundred seventy-three patients survived to undergo screening, 304 were diagnosed with ROP, and 66 infants required diode laser therapy. MAIN OUTCOME MEASURES: Success of treatment, visual and refractive outcomes. RESULTS: One hundred twenty-eight eyes from 66 infants (18.8% of those screened) underwent laser treatment with a mean GA of 24.3 weeks and mean birth weight of 711.4g. Fifty-six eyes were treated at pre-threshold disease, and 72 eyes at threshold disease. Over the study period, the number of laser spots and regression rate of ROP increased, while the frequency of re-treatment decreased. At 40 weeks, 119 eyes had regressed ROP (93%), two advanced to stage 4a, three to stage 4b and four to stage 5. Aggressive posterior ROP (AP-ROP) occurred in 15 eyes (11.7% of those treated). Forty-three patients (65%) were followed up for a mean of 56.5 months. The number of laser spots correlated well with subsequent refractive error but poorly with corrected visual acuity. CONCLUSIONS: In EP infants, laser diode therapy is an effective technique to halt the progression of ROP in most cases. AP-ROP is uncommon, even in this subgroup of extremely premature infants.

The paediatric optometry alignment program - a model of interprofessional collaborative eyecare.

CLINICAL RELEVANCE: Collaboration  between hospital-based ophthalmology and community-based optometry could pave the way to improve access to paediatric eyecare services. BACKGROUND: The Paediatric Optometry Alignment Program (POAP) began in 2016 as a proof-of-concept pilot project that aimed to improve access to specialist paediatric ophthalmology services. If found to be effective at improving patient access, and the quality of care acceptable to patients and professionals then the strategic intent was to upscale the programme to  serve as a model for paediatric eye care in the community. METHODS: Temporal observational trend analysis was used to review ophthalmology clinic appointment waitlists prior and post POAP pilot project commencement. Family satisfaction with post-discharge care was surveyed in a purposive sample of 30 patients.  Aligned optometrists in the program pilot (n = 97) were invited to complete an online survey (response rate 46%; n = 45). RESULTS: The percentage of children waiting longer than clinically recommended fell from 72% to 36%. Sixty-seven percent  of surveyed families had attended a community optometrist as recommended, and all rated the optometry experience from good to excellent.  Participating optometrists reported high levels of satisfaction with involvement in the program, and increased confidence and involvement in paediatric eye care delivery. The need to improve formal transfer  of clinical information was identified. CONCLUSION: Facilitated integrated care between community-based optometrists and a hospital-based ophthalmology department can improve access for tertiary care services, with high satisfaction for families and participating community-based optometrists.

Development of a joint set of database parameters for the EU-ROP and Fight Childhood Blindness! ROP Registries.

BACKGROUND/AIMS: The incidence of retinopathy of prematurity (ROP) is increasing and treatment options are expanding, often without accompanying safety data. We aimed to define a minimal, patient-centred data set that is feasible to collect in clinical practice and can be used collaboratively to track and compare outcomes of ROP treatment with a view to improving patient outcomes. METHODS: A multinational group of clinicians and a patient representative with expertise in ROP and registry development collaborated to develop a data set that focused on real-world parameters and outcomes that were patient centred, minimal and feasible to collect in routine clinical practice. RESULTS: For babies receiving ROP treatment, we recommend patient demographics, systemic comorbidities, ROP status, treatment details, ophthalmic and systemic complications of treatment, ophthalmic and neurodevelopmental outcomes at initial treatment, any episodes of retreatment and follow-up examinations in the short and long-term to be collected for use in ROP studies, registries and routine clinical practice. CONCLUSIONS: We recommend these parameters to be used in registries and future studies of ROP treatment, to reduce the variation seen in previous reports and allow meaningful assessments and comparisons. They form the basis of the EU-ROP and the Fight Childhood Blindness! ROP Registries.

Incidence of retinopathy of prematurity in extremely premature infants over an 18-year period.

BACKGROUND: To report the incidence of retinopathy of prematurity (ROP) in a subgroup of extremely premature infants admitted to an Australian tertiary centre over an 18-year period. DESIGN: Retrospective study. Royal Brisbane and Women's Hospital Neonatal Intensive Care Unit. PARTICIPANTS: Five hundred and fifty-four infants admitted between 23 and 25.6 weeks gestational age (GA). METHODS: The 18-year study was divided into three 6-year periods for analysis: period 1 (1992-1997), period 2 (1998-2003) and period 3 (2004-2009). Infants were compared based on their week of GA and by the study period in which they were born. MAIN OUTCOME MEASURES: GA, birthweight, incidence and severity of ROP. RESULTS: Three hundred seventy-three (67.3%) infants survived until ROP screening, and 351 (63.4%) survived until discharge. ROP incidence increased from 78.2% in period 1 to 86.1% in period 3. Over the entire study, 90.5% of 23-week GA infants had ROP compared with 89.7% of 24-week GA infants and 76.1% of 25-week GA infants. Mean birthweight was significantly lower in infants with any ROP (725.1 g) and ROP of at least stage 3 (720.8 g) compared with infants without ROP (806.5 g) (P < 0.0001). Twenty-three-week GA infants had more severe ROP (28.6%) than 24 weeks (18.3%) and 25 weeks GA (11.9%). CONCLUSIONS: There has been increased survival and incidence of ROP in extremely premature infants over the past 20 years. Lower birthweight and GA are both associated with higher incidence and more severe ROP.

Trampoline Use and Retinal Detachment in Stickler Syndrome.

Stickler syndrome is one of the most common inherited causes of retinal detachment in childhood. We present the case of a 6-year-old boy with Stickler syndrome who developed a retinal detachment in his better seeing eye after prolonged trampoline use. We suggest that trampolining should be avoided in all patients at increased risk of retinal detachment, especially in Stickler syndrome, and in those with other risk factors including high myopia and previous retinal detachments.

Clinimetric properties of visuo-perceptual and visuo-cognitive assessment tools used for children with cerebral visual impairment and cerebral palsy or developmental delay: a systematic review.

PURPOSE: The aim of this systematic review is to evaluate the psychometrics and clinical utility of visuo-perceptual and visuo-cognitive assessment tools in children with cerebral visual impairment (CVI) and cerebral palsy (CP) or neurodevelopmental delay (DD). MATERIALS AND METHODS: Five databases (PubMed, EMBASE, SCOPUS, CINAHL, and Cochrane Database) were comprehensively searched from 1970 till June 2021. The PRISMA checklist was utilised to report on the process of selecting eligible papers. The methodological quality of included studies was evaluated using COnsenus-based Standards for the selection of health Measurement INstrument (COSMIN) checklist. RESULTS: Of the 26 assessment tools identified, only seven tools had psychometric evidence supporting their use. Based on COSMIN guidelines, 60% of included studies were rated as inadequate or doubtful for their methodological quality of measurement properties, with equal number being rated as indeterminate on the overall rating. CONCLUSIONS: Cerebral visual impairment due to its varied clinical presentation is often missed in children with CP and DD. There is a paucity of studies reporting on the validity and reliability of functional vision tools. Further studies are needed to conduct high-quality psychometric reporting using the updated COSMIN guidelines to identify appropriate functional vision tools for children with CP or DD.Implications for rehabilitationThere are paucity of studies evaluating the validity and reliability of existing perceptual and cognitive assessment tools in children with cerebral visual impairment (CVI) and cerebral palsy (CP).Development of age-appropriate assessment tools evaluating all aspects of functional vision will assist in providing more holistic child-centric rehabilitation programs.A combination of detailed perinatal history, direct observation, and clinical assessments of functional vision are important to recognise CVI in children with CP.

Use of the electroretinogram in a paediatric hospital.

BACKGROUND: To review the use of electroretinography and identify common reasons for referral and diagnoses at a tertiary paediatric hospital. DESIGN: Retrospective cohort study. PARTICIPANTS: Three hundred and eighteen patients (male 195, female 123) aged <18 years with 388 electroretinograms were included. METHODS: All electroretinograms performed at the Royal Children's Hospital, Brisbane from 1998 to 2005 were reviewed. Normative data and electroretinograms from patients aged ≥18 years were excluded. MAIN OUTCOME MEASURES: Reasons for referral and diagnoses were determined from each patient's first electroretinogram. Concordance between the first electroretinogram diagnosis and clinical referral was reviewed to determine whether the electroretinogram was normal, inconclusive, confirmed, excluded, or changed the clinical diagnosis or provided a new diagnosis. RESULTS: The median age at the time of the first investigation was 3.78 years (range 2.6 weeks to 17.5 years). The most common reasons for referral were nystagmus (n = 93), decreased vision (n = 33) and sensorineural deafness (n = 29). After one electroretinogram, 51% were normal (n = 162) and 15% were inconclusive (n = 49). The most common electroretinography diagnosis was cone rod dystrophy. The first electroretinogram for each patient confirmed the clinical suspicion in 17.6% (n = 56) and excluded it in 23% (n = 73) of cases. The electroretinogram resulted in a changed diagnosis in 0.9% (n = 3) and provided a new diagnosis in 15.1% (n = 48). Overall, the first electroretinogram was considered useful in 85% cases (n = 269). CONCLUSIONS: Electroretinography is a valuable investigation for evaluating paediatric eye disease and in this series confirmed, excluded, changed or provided a new diagnosis in 85% of cases.

Specific amacrine cell changes in an induced mouse model of glaucoma.

BACKGROUND: To investigate retinal cell population changes under chronic elevated intraocular pressure in an inducible mouse model of glaucoma. METHODS: Chronic unilateral ocular hypertension was induced in 40 C57BL6/J mice by ablation of the limbal episcleral veins. After 5, 20, 40 and 60 days of elevated intraocular pressure, specific retinal cell types were identified and/or quantified by immunohistochemistry for protein kinase C α, glial fibrillary acidic protein, parvalbumin and calretinin. Apoptotic cells were identified by TUNEL and cleaved caspase-3 immunohistochemistry. RESULTS: Elevations in intraocular pressure in the range 22-30 mmHg were developed and sustained in mice for up to 60 days. Protein kinase C α immunoreactivity localized to bipolar cells was unchanged. We observed a rapid increase in glial fibrillary acidic protein expression in Müller cells and a progressive loss of parvalbumin-labelled ganglion cells. After 60 days of elevated intraocular pressure, calretinin-immunoreactive cell counts declined by 55.4% and 46.4% in the inner nuclear and ganglion cell layers, respectively. However, at all time points examined, the markers of cell death were only observed in the ganglion cell layer, not in the inner nuclear layer. CONCLUSIONS: In addition to ganglion cell death and reactive Müller cell changes, chronic experimental elevation of intraocular pressure alters calcium-binding protein immunohistochemistry in amacrine cells. However, these changes are not indicative of amacrine cell loss but may represent early indicators of cellular distress that precede physiological dysfunction or cell death.

Amniotic Membrane-Covered Conformer and Fibrin Glue for Toxic Epidermal Necrolysis.

PURPOSE: Stevens-Johnson syndrome and its more severe form, toxic epidermal necrolysis, are immunologic disorders that cause widespread blistering of the skin and mucous membranes. Its incidence is higher in children and can lead to long-term disabling ocular surface complications that can be averted with amniotic membrane transplantation early in the disease. To introduce an amniotic membrane treatment technique that is time efficient and minimally invasive but still allows for extensive coverage of the ocular mucosal surfaces to prevent and lessen the severity of the complications from ocular surface sequelae. METHODS: The procedure was undertaken in the operating room under general anesthesia. Symblephara were divided before an amniotic membrane-covered conformer was placed into the fornices. Fibrin glue was used to secure the conformer and to keep the palpebral aperture closed. Topical chloramphenicol 0.5% and prednisolone 0.5% were prescribed 4 times a day. RESULTS: After 7 days, the conformers were removed and new amniotic membrane-covered conformers were reapplied in both eyes for a further week. After the second round of treatment, the conformers were left out for 3 days. Inferior symblephara reformed in the left lower fornix, and therefore, a third round of treatment was undertaken in the left eye only, which was then removed after 7 days. A follow-up at 8 weeks revealed 20/20 vision with minimal symblephara in either eye. CONCLUSIONS: This novel technique, using an amniotic membrane-covered conformer in combination with fibrin glue, allows for the coverage of the entire ocular surface and protection of the lid margins while requiring minimal preparation and surgical time. This technique could also be used in patients with other cicatrizing ocular surface conditions, such as chemical or thermal injuries or postreconstructive surgery of the fornices.

The amblyopic deficit and its relationship to geniculo-cortical processing streams.

Amblyopia or lazy eye is the most common cause of uniocular blindness in adults and is caused by a disruption to normal visual development as a consequence of unmatched inputs from the two eyes in early life, arising from a turned eye (strabismus), unequal refractive error (anisometropia), or form deprivation (e.g., cataract). Using high-field functional magnetic resonance imaging in a group of human adults with amblyopia, we previously demonstrated that reduced responses are observable at a thalamic level, that of the lateral geniculate nucleus (LGN). Here we investigate the selectivity of this deficit by using chromatic and achromatic stimuli that are designed to bias stimulation to one or other of the three ascending pathways (the parvocellular, magnocellular, and koniocellular). We find the greatest LGN deficit is for stimuli modulated along the chromatic, L/M cone opponent axis of color space, suggesting a selective loss of parvocellular function in the LGN. We also demonstrate a cortical deficit that involves all the visual areas studied (V1, V2, V3, VP, V3A, V4), and we find this is greatest for the two chromatic responses (S cone opponent and L/M cone opponent) versus the achromatic response, as might be expected from a loss of segregation of chromatic pathways in the cortex.

The calcineurin inhibitor, FK506, does not alter glutamate transport in the ischaemic mouse retina.

The protein phosphatase 2B inhibitor, FK506, is an immunomodulatory polypeptide that has neuroprotective properties, the mechanisms of which have not been elucidated. A possible mechanism may be phosphorylation-mediated regulation of glutamate transporter activity. In the present study, we investigated the effect of FK506 on glutamate transporter localization and activity in the ischaemic mouse retina. FK506 did not appear to modulate the localization or activity of glutamate transporters under simulated ischaemic conditions. Our present data suggest that the mechanism by which FK506 exerts its neuroprotective action is not attributable to alterations in retinal glutamate transport.

Propranolol in the management of periorbital infantile haemangioma.

BACKGROUND: Infantile haemangiomas are the commonest tumours of the orbit in children. Treatment is usually expectant, unless they are visually threatening. Although steroids, other pharmacological and surgical treatment modalities have their place, there are risks involved. A previous case series reported the successful use of propranolol for infantile haemangioma. The safety and efficacy of propranolol in the treatment of periorbital haemangioma was reviewed in a serious of our patients. METHODS: We performed a retrospective review of patients seen by two ophthalmologists (TJS and GAG), collecting data on colour, size of lesion, duration of treatment and side-effects of treatment. Our main outcome measures were colour and size of infantile haemangioma before and after treatment, the change in astigmatism of our patients and the incidence of complications from propranolol. RESULTS: We reviewed 10 patients with infantile haemangioma. They were treated with propranolol oral syrup 2 mg/kg/day in divided doses for a mean duration of 32.8 (range 12-42) weeks. All our patients had a reduction in colour and size of the lesions. The mean lesion size decreased from 756.7 to 543.2 mm(2) after treatment (P = 0.075). Five patients had significant astigmatism and 60% had successful reduction of astigmatism after treatment. None of our patients suffered significant side-effects of propranolol. CONCLUSION: Propranolol appears to be a safe and effective treatment in the management of infantile haemangioma.

Acute red eye in children: A practical approach.

BACKGROUND: Acute red eye in a child is a common ocular presentation in general practice. It can arise from a wide spectrum of pathologies and involve various ocular structures. OBJECTIVE: The aim of this article is to provide a framework for the general practitioner to assess and manage a child presenting with a red eye, with a focus on cases that require immediate referral. DISCUSSION: Most paediatric red eyes are benign and can be safely managed in general practice. However, this requires thorough history-taking and examination together with the ruling out of red flags. Assessment of a child with a red eye may pose specific challenges that can usually be overcome by focused history-taking and opportunistic examination. Urgent referral for examination under sedation or anaesthesia is indicated when there is suspicion of a vision-threatening cause and/or assessment in the clinic is unsuccessful.