Epiphora (watery eyes/blocked tear ducts)

PAEDIATRIC

  • 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 occulsion

    • Patients with central or branch retinal artery occlusion

    Glaucoma

    • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
    • 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

    Adult/paediatric strabismus

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

    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 registrar)

    Anisocoria (unequal pupil size)

    • If acute onset and associated with neurological signs

    Chalazion/meibomian cyst

    • Chalazion with an abscess

    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

  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service  would be triaged as a Cat 1

    Statement of intent – the prioritisation of health services for children and young people in the child protection system

    • Refer to Healthpathways or local guidelines
    • Lacrimal sac massage technique taught to parents
    • Monitor watery eye for first 12 months
    • Please consider the following:
      • Is there accompanying photophobia?
      • Are one or both eyes enlarged?
    • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: Department of Children, Youth Justice and Multicultural Affairs
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Children with watery eyes (epiphora) from birth with accompanying photophobia and one or both eyes are enlarged (horizontal corneal diameter >12.0mm)
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • Children with epiphora from birth non resolved after 12 months with no other features

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Any reduced vision?
  • Any cloudy cornea?
  • Any lids swelling?
  • Confirmation of out-of-home-care (OOHC) (where appropriate)

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • 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.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 20 December 2018

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