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.

  • nil

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

  • baseline ophthalmic screening/testing after recent commencement for medication/s of concern

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • medication related complications with visual field changes and any of the following:
    • optic neuropathy from amiodarone (cordarone) or ethambutol (mymabutol) usage
    • macular oedema from fingolimod (gilenya) usage
    • bull’s eye maculopathy from hydroxychloroquine (plaquenil) usage
    • crystalline maculopathy/macular oedema from tamoxifen (nolvadex) or canthaxanthin usage
    • ischemic retinopathy/optic neuropathy from interferon-alfa usage
    • angle closure glaucoma from topiramate (topamax, anticholinergics, antihistamines, antipsychotics) usage
    • idiopathic intracranial hypertension from tetracycline use

Category 2 (appointment clinically indicated within 90 days)

  • ocular hypertension associated with steroid use
  • medication related complications without visual field changes and any of the following:
    • optic neuropathy from amiodarone (cordarone) or ethambutol (mymabutol) usage
    • macular oedema from fingolimod (gilenya) usage
    • bull’s eye maculopathy from hydroxychloroquine (plaquenil) usage
    • crystalline maculopathy/macular oedema from tamoxifen (nolvadex) or canthaxanthin usage
    • ischemic retinopathy/optic neuropathy from interferon-alfa usage
    • angle closure glaucoma from topiramate (topamax) usage
  • ethambutol screening
  • field restriction from vigabartin (sabirl), gabapentin
  • retinopathy from suspected recreational drug usage
  • plaquenil use for greater than 5 years
  • plaquenil use with macula pathology and/or liver/kidney impairment
  • ocular inflammation (episcleritis, uveitis) with bisphosphosphonate use
  • diabetic macular oedema with glitazone use

Category 3 (appointment clinically indicated within 365 days)

  • plaquenil use - cumulative dose (1kg consumption)
  • pentosal phosphates – cumulative dose (500g consumption)

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
  • smoking/vaping history
  • ocular history, including:
    • symptoms and duration of clinical presentation
    • previous trauma if relevant
    • surgery and medical management, including glasses and/ or amblyopia therapy
    • familial history of eye disease
    • medication management
    • other eye conditions, for example unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity
    • retinal examination
    • slit lamp examination where possible
    • central automated visual field 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
  • optical coherence tomography (OCT)
  • optometrist report less than 6 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

Idiopathic intracranial hypertension from tetracycline use can be referred to Ophthalmology as well as several other specialities below to make a diagnosis. If the patient requires ophthalmological assessment or diagnosis, please refer to ophthalmology.

It is important to ensure that the doctor who prescribed the medication is informed of any correspondence, assessments, and reports related to complications or side effects experienced by the patient during medication therapy.

Hydroxychloroquine and chloroquine are metabolised by both the kidney and liver. Patients with significant renal and/or hepatic impairment are recommended to have baseline screening followed by annual eye screening from treatment initiation.

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.