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Andrew W Kam,1– 3 Nathan Gunasekaran,1 Sarah G Chaudhry,1 Matthew Vukasovic,4 Andrew JR White,1,3,5 Adrian T Fung1,3,5,6 1Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia; 2Executive Unit, Westmead Hospital, Westmead, New South Wales, Australia; 3Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; 4Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia; 5The Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia; 6Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, AustraliaCorrespondence: Adrian T FungDepartment of Ophthalmology, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, AustraliaTel +1 612 9845 6668‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Email adrian.fung@sydney.edu.auPurpose: To examine changing patterns of ophthalmic presentations to emergency departments (EDs) during the lockdowns associated with the first wave of the COVID-19 pandemic in Australia and the two months immediately following lockdown relaxation.Patients and Methods: This was a retrospective audit of triage coding and ICD-10-AM coding for all patient presentations to four Australian EDs from March 29 to May 31 in 2019 and 2020 (the COVID-19 lockdown period and the corresponding period in 2019), and from June 1 to July 31 in 2019 and 2020 (the post-lockdown period and the corresponding period in 2019). Number of ophthalmic presentations triaged per day and number of seven common and/or time-sensitive, vision threatening ophthalmic diagnoses were examined. Differences in mean daily presentation numbers were assessed with non-paired Student’s t-test with Bonferroni correction.Results: Total ophthalmic presentations per day during COVID-19 lockdowns fell by 16% compared to the corresponding period in 2019 (13.0 ± 4.0 in 2019 vs 10.8 ± 3.3 in 2020, mean ± standard deviation; p=0.01). There was also a significant decrease in presentations of atraumatic retinal detachment, conjunctivitis, and eye pain. In the two months following easing of lockdown restrictions, total ophthalmic presentations per day returned to the same level as that of the corresponding period in 2019 (12.2 ± 4.3 in 2019 vs 12.3 ± 4.1 in 2020, p=0.97).Conclusion: Total ophthalmic presentations and presentations of atraumatic retinal detachment, conjunctivitis and, eye pain to EDs fell during the lockdowns associated with the first wave of COVID-19 in Australia. These may represent delays in patients seeking appropriate medical attention and may have implications on patient morbidity long after the COVID-19 pandemic.Keywords: COVID-19, emergency medicine, ophthalmic epidemiology, retinal detachment, public health