Nystagmus - Paediatric CPC

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

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Exclusions

• second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• child aged under 2 years with congenital or infantile onset nystagmus
• any child with associated neurological signs and/or systemically

Category 2 (appointment clinically indicated within 90 days)

• pre-literate child greater than 2 years of age with long standing nystagmus
• literate child with long standing nystagmus, best corrected visual acuity (BCVA) 6/12 or worse

Category 3 (appointment clinically indicated within 365 days)

• literate child with long standing nystagmus BCVA better than 6/12

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 - visual acuity chart
  • preschool children – picture or letter matching chart
  • pre-literate children - visual behaviour e.g. ability to fix and follow an object of interest
  • describe waveform of nystagmus – direction, type, amplitude, frequency and determine if null point exists
• photograph with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate

Clinical management advice

Nystagmus observed in infants can indicate visual impairment. If nystagmus is congenital or develops during infancy, it is important to refer the child for specialist outpatient service review. Acquired nystagmus is typically not associated with ophthalmic conditions, and referral to a neurologist should be considered.

Clinical resources

• NSW Health – Eye Emergency Manual: An Illustrated Guide, Second Edition
• Women’s and Children’s Hospital Ophthalmology Fact sheets

Consumer resources

• American Association for Paediatric Ophthalmology and Strabismus - Nystagmus
• Women’s and Children’s Hospital Ophthalmology Fact sheets

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.