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.

  • sudden onset ptosis

Assess and exclude acute neurological event including stroke or transient ischemic attack (TIA) prior to referring and consider contacting the nearest on-call stroke service where neurological features are present.

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

  • dry eye disease
  • cosmetic concerns
  • excess or saggy eyelid skin that does not affect visual fields
  • internal hordeolum (stye) without suspected preseptal or orbital cellulitis

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected malignancy
  • ectropion with incomplete eye closure with keratopathy
  • sudden onset of ptosis with- neurological features
  • symptomatic entropion with epithelial damage
  • internal hordeolum (stye) with suspected preseptal or orbital cellulitis

Category 2 (appointment clinically indicated within 90 days)

  • symptomatic ptosis involving visual axis

Category 3 (appointment clinically indicated within 365 days)

  • dermatochalasis affecting visual fields
  • ptosis involving visual axis without neurological features
  • entropion/ectropion causing epiphora
  • small protrusions/lumps or bumps on the eyelid that result in damage to the cornea when blinking

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/surgical history
  • current medications, allergies
  • ocular history, including:
    • symptoms and duration of clinical presentation
    • surgery and medical management
    • diabetes history
    • medication management
    • other eye conditions, for example unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity
    • check for corneal epithelial damage with fluorescein
    • automated visual fields examination
  • 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 12 months old at time of referral
  • photograph – with patient’s consent, where secure image transfer, identification and storage is possible where appropriate

Clinical management advice

Please note that referrals for ectropion/entropion can be managed by the following specialist services:

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.