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PURPOSE To describe follow-up rates for patients referred for outpatient ophthalmic care after emergency department (ED) discharge and identify patient and visit characteristics associated with loss to follow-up (LTFU). DESIGN Single-institution retrospective cohort study. METHODS We analyzed the medical records of 2,206 patients seen in the ED for an eye-related issue who were subsequently scheduled for ophthalmology follow-up between 2013-2019 at a single tertiary health system. The main outcome measures were the frequency of and risk factors for LTFU and ED revisits. RESULTS In total, 1649 (74.8%) completed follow-up within 2-months of an index ED visit. On multivariable analysis, younger age (p<0.001), a nonurgent ophthalmic condition or non-ophthalmic primary diagnosis (p<0.001), scheduled follow-up >5 days after the ED visit (p<0.001), additional follow-up appointments (<0.001), no prior history of ophthalmology appointments (p=0.045), visual acuity of 20/40 or better (p=0.027), and having Medicaid or being uninsured (p<0.001) were significantly associated with LTFU. The presence of an interpreter significantly increased the likelihood of follow-up among non-English speaking patients (p<0.001). LTFU was significantly associated with an ED revisit within 4-months of an index visit and the ED revisit rate was significantly higher for patients LTFU versus those who completed follow-up (5.7% vs. 1.1%; p<0.001). CONCLUSIONS A quarter of patients referred for ophthalmic care following an ED presentation were LTFU. We identified multiple factors associated with LTFU that could be used to develop interventions to enhance follow-up. Additionally, patients who were LTFU were more likely to revisit the ED for the same ophthalmic condition.