Whilst Italian optometrists refract patients and prescribe optical appliances, it is ophthalmologists who are responsible for the detection, diagnosis, and treatment of ocular pathology. In settings with similar scope of practice, close collaboration between optometrists and ophthalmologists is required to minimise avoidable visual impairment. Referral to ophthalmology represents the basis of this synergy, yet no formal guidance is available to Italian optometrists indicating when referrals are warranted. This study aimed to identify circumstances deserving a referral in a routine Italian optometric examination in adults, constituting preliminary evidence-based indications of a referral model. A literature review was conducted using Pubmed and the Cochrane Library. To derive clinical guidance, the main focus was high quality secondary literature such as systematic reviews and clinical guidelines. Several signs and symptoms detected during a routine Italian optometric exam might constitute reasons for referral. Further, while awide range of anomalies of the visual systemare likely to be detected by the exam, up to 19% of patients could suffer an asymptomatic condition potentially undetected by the current assessment. This results in the need to refer seemingly healthy patients if they have not attended routine ophthalmological examinations within optimal time frames. The current training and scope of practice of Italian optometrists requires close collaboration with ophthalmologists to safeguard the ocular health of patients. Referral is a fundamental instrument that in Italy, and countries with similar settings, optometrists must use to enable early diagnosis and treatment of ocular conditions by ophthalmologists. We have presented a preliminary evidence-based framework for optometric referral which identifies categories constituting reasons for referral. This has the potential of standardising optometric practice, enhancing optometry-ophthalmology synergism and, more importantly, improving ocular and general wellbeing of patients.