Referral Pathways for Ophthalmic Emergencies from Primary to Tertiary Care in Imo State

Effective referral pathways are essential to ensure patients with ocular emergencies receive timely, appropriate specialist care that can prevent irreversible vision loss. This study examines referral pathways for ophthalmic emergencies from primary to tertiary care in Imo State, South East Nigeria. A mixed-methods cross-sectional design will be used. Quantitative data will be obtained from referral registers at 15 primary health centres and three general hospitals, documenting the number, type, and outcome of ophthalmic emergency referrals. Qualitative data from semi-structured interviews with community health officers, general practitioners, and ophthalmologists at Federal Medical Centre Owerri will explore perceived barriers to timely referral, communication failures, and patient journey experiences. Referral documentation quality and time from initial presentation to specialist care will be key metrics. Delays in referral for conditions such as acute angle-closure glaucoma, corneal ulceration, and retinal detachment are frequently documented in Nigerian health systems research, resulting in preventable visual morbidity. This study identifies specific pathway breakdowns in the Imo State health system. Recommendations will include standardised ophthalmic emergency referral forms, dedicated emergency ophthalmology hotlines, ambulance coordination protocols, and training of primary care providers in identifying and stabilising ocular emergencies prior to referral. Strengthening ophthalmic emergency referral chains across all three tiers of the Imo State health system is essential to reducing avoidable visual disability in the region. Keywords: referral pathways, ophthalmic emergency, primary to tertiary care, Imo State, health systems