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.

  • suspected injury that has penetrated the eye - see eye trauma
  • microbial keratitis - infection of the cornea
  • painless, white corneal lesion - corneal ulcer
  • shield corneal ulcer related to allergy/atopy
  • dendritic ulcer on staining
  • hyphema
  • hypopyon
  • red eye in previous corneal transplant patient

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.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • correctable keratoconus with spectacles or contact lenses

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • keratoconus with corneal hydrops
  • Fuch’s (Fuchs’) endothelial dystrophy and corneal decompensation with bullae
  • severe blepharon-keratoconjunctivitis (blepharoconjunctivitis) with best corrected visual acuity (BCVA) less than 6/12

Category 2 (appointment clinically indicated within 90 days)

  • pterygium greater than 3mm (3.5mm) from limbus to apex with visual axis threatened and/or dysplasia
  • Fuch’s and BCVA worse than or equal to 6/36

Category 3 (appointment clinically indicated within 365 days)

  • pterygium greater than 3mm from limbus to apex without visual axis being threatened and/or dysplasia
  • keratoconus with progressive disease including any of the following:
    • visual distortions/refractive errors such as myopia, presbyopia, hyperopia, and astigmatism
    • decreased visual acuity
    • blurred/double vision
    • photophobia
  • Fuch’s and BCVA worse than 6/12 but better than 6/36

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.

  • relevant past medical and surgical history
  • current medications, allergies
  • ocular history, including:
    • symptoms and duration of clinical presentation
    • surgery and medical management, including glasses and/ or amblyopia therapy
    • medication management
    • other eye conditions for example, unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity
    • pinhole visual acuity in each eye
    • inspection of abnormalities of eye and eyelid with slit lamp if possible
    • assessment of retina for any co-existent pathology
    • intraocular pressure where possible
    • corneal morphology and biometry for example, topography, pachymetry if appropriate
  • relevant social information including:
    • employment/education associated implications
    • carer for partner/family member
    • lives alone, unable to manage daily activities due to vision loss
  • optometrist report less than 3 months old at time of referral
  • photograph – with patient’s consent, where secure image transfer, identification and storage is possible where appropriate

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.