The authors examined malpractice lawsuits related to ophthalmology telemedicine telephone triage in the US. The study reviewed a total of 510 lawsuits and identified 18 cases that involved synchronous telephone visits, while none involved video telecommunication. The study found that 94.5% of cases (17/18) alleged a delay in evaluation and / or treatment following telephone triage. 44.4% of lawsuits alleging delays were because the ophthalmologist did not instruct the patient to come into the office immediately or offer an immediate in-person examination. A further 38.9% of cases alleged delays because the ophthalmologist did not provide an in-person evaluation of the patient in the emergency department (ED), but instead managed the case via telephone with history, examination and assessment from an ED physician or physician associate. Other lawsuits include incorrect diagnoses, delayed and improper discussions of risks and informed consent. The cases involved a variety of conditions, including retinal detachment, endophthalmitis, ocular trauma and allergic reactions. 66.7% of the lawsuits listed the on-call or consulting ophthalmologist as the defendant. Examining lawsuit outcomes, 38.9% of cases favoured the defendant and 27.8% of cases ruled in favour of the plaintiff. Monetary awards were visible in 16.7% of cases, with settlements and awards ranging from $252,117.30 to $7,563,518.96, with an average of $2,894,366. To conclude, the study suggests that while litigation arising from telemedicine in ophthalmology is rare, it is not without risk, and proper protocols should be established to minimise the potential for malpractice lawsuits.