Referral to emergency

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

  • cellulitis unresponsive to oral antibiotics
  • preseptal/orbital cellulitis - worsening eyelid oedema, erythema
  • chalazion with an abscess

For the following symptoms, contact the ophthalmology registrar prior to referring to the emergency department:

  • atypical presentation/ suspicion of malignancy

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • children aged under 4 years with chalazion/stye, present less than 3 months
  • children aged over 4 years with chalazion/stye, present less than 6 months
  • second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • children aged under 4 years with chalazion/stye persisting longer than 3 months

Category 3 (appointment clinically indicated within 365 days)

  • children aged over 4 years with chalazion/stye persisting longer than 6 months

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

  • antenatal, birth, developmental, medical, family history. Note any developmental or behavioural issues such as autism spectrum disorder (ASD), and attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD)
  • ocular history, including:
    • other eye conditions
    • eye trauma
    • surgery and medical management, including glasses and/ or amblyopia therapy
  • eye and vision examination in both eyes:
    • literate children using a visual acuity chart
    • preschool children using a picture or letter matching chart
    • pre-literate children using a visual behaviour e.g. ability to fix and follow an object of interest
  • photograph – with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate

Clinical management advice

Chalazion is an inflamed cyst within the eyelid meibomian gland. It is extremely common in all age groups. Often it will undergo cycles of waxing and waning. 

Conservative management

Conservative management includes:

  • the affected eyelid(s) should receive daily warm compresses for a minimum of 4 weeks, with each application lasting for at least 2 minutes, followed by a gentle massage if possible
  • the ideal result is the natural draining of the cyst's contents without any intervention

Concerning features may include:

  • eyelid bumps that grow continuously, particularly if there is no accompanying inflammation, or if they extend beyond the eyelid's boundaries
  • loss of eyelashes
  • little to no response to conventional treatment methods.

Concerns of periorbital cellulitis

Where concerns of periorbital cellulitis exist:

  • commence oral antibiotics
  • mark/outline the red areas of the skin (erythema)
  • arrange a follow-up appointment with the patient within 24 to 48 hours
  • if unresponsive to treatment, seek emergent medical attention

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient 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

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • 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 pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.