Ophthalmology

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    NB - in an emergency of any of the following, its advised to arrange immediate transfer to the emergency department.

    Adult

    Retinal artery occlusion

    • Patients with central or branch retinal artery occlusion

    Glaucoma

    • Angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, 'rainbows' around lights, or sluggish pupil reactions)
    • Patients with IOP >35mmHg

    Strabismus (squint) and Diplopia

    • Sudden onset of any of the following:
      • constant convergent squint (esotropia) or
      • divergent squint (exotropia) or
      • double vision at any age

    Ptosis

    • Sudden onset ptosis if concern regarding neurological cause i.e. 3rd cranial nerve palsy

    Other referrals to emergency

    • Sudden severe visual loss e.g., macular or vitreous haemorrhage, retinal detachment or retinal artery occlusion
    • Rubeosis iridis (iris new vessels)
    • Corneal graft rejection
    • Contact lens keratitis, corneal ulcers
    • Uveitis/scleritis
    • Intra ocular pressure (IOP) > 35 mmHg
    • Signs and/or symptoms of retinal detachment
    • Acute injury e.g., trauma, burns, chemical exposure, foreign body
    • Acutely inflamed eye
    • Preseptal/orbital cellulitis - worsening eyelid oedema, erythema and proptosis
    • Ocular signs or symptoms of temporal arteritis
    • Ophthalmology conditions associated with sudden onset neurological signs and/or symptoms e.g., third cranial nerve palsy or optic disc swelling

    Paediatric

    Leukocoria

    • White red reflex (refer directly by telephone to the on-call ophthalmology doctor)

    Anisocoria (unequal pupil size)

    • If acute onset and associated with neurological signs

    Chalazion/meibomian cyst

    • Periorbital cellulitis associated with infected chalazion

    Reduced visual acuity

    • Sudden severe vision loss in a child

    Elevated optic nerve head

    • If neurological anomaly signs (vomiting, abnormal pupils, severe headache)
    • If Retinal haemorrhages or exudates

    Ptosis

    • Sudden onset of persistent Ptosis

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • The following are not routinely provided in a public Ophthalmology service.

    • Cataract (patients with best corrected visual acuity in the affected eye of 6/12 or better will not be accepted unless clinical modifiers apply (see general referral information section)
    • Diabetic retinopathy (routine referral for screening without evidence of diabetic retinopathy or patients with only mild no proliferative (NPDR) will not be accepted unless in those HHSs without primary photo screening or optometrist)
    • Age related macular degeneration (AMD) (dry AMD is not routinely seen unless the practitioner is concerned about progression to wet AMD)
    • Glaucoma (patients with ocular hypertension with IOP less than 25mmHg and no other signs or risk factors for glaucoma will not be accepted)
    • Pterygium (pterygium less than 3mm from limbus to apex will not be accepted)
    • Lid lesions (patients with minor cosmetic eyelid lesions should not be referred)
    • Isolated refractive error - (prescription of spectacles)
    • Mild dry eyes
    • Mild ptosis

Last updated: 20 December 2018

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