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.

  • optic disc swelling with neurological features

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

  • severe papilloedema
  • optic disc swelling with vision loss

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

  • second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected malignancy
  • increased optic disc swelling
  • optic disc swelling with suspicious symptoms including:
    • recent increase in severity or frequency of headaches
    • recent behavioural change in pre-verbal children
    • headaches are positional, worse on lying down
    • waking with headaches
    • associated pulsatile tinnitus (whooshing sound in time with the heart-beat)
    • associated nausea, vomiting, sensitivity to light
    • double vision
  • known craniofacial or neurosurgical condition, with suspicious symptoms, including:
    • changes on neuroimaging to suggest raised intracranial pressure
    • recent increase in severity or frequency of headaches
    • recent behavioural change in pre-verbal children
    • headaches are positional, worse on lying down
    • waking with headaches
    • pulsatile tinnitus (whooshing sound in time with the heart-beat)
    • nausea, vomiting, sensitivity to light
    • double vision

Category 2 (appointment clinically indicated within 90 days)

  • previously diagnosed stable optic disc swelling
  • known craniofacial or neurosurgical condition screening for optic disc swelling

Category 3 (appointment clinically indicated within 365 days)

  • nil

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
  • history of headaches
    • recent increase in severity or frequency
    • recent behavioural or cognitive change
    • positional, worse on lying down
    • waking with headaches
    • associated pulsatile tinnitus (whooshing sound in time with the heart-beat)
    • associated nausea, vomiting, sensitivity to light
  • eye and vision examination in both eyes:
    • literate children - visual acuity chart
    • preschool children - picture or letter matching chart
    • literate and preschool children - colour vision
    • pre-literate children
      • visual behaviour e.g. ability to fix and follow an object of interest
      • pupillary light reactions and red reflexes
      • cover/uncover test
      • assessment of ocular motility
  • neurological examination
  • optometrist report within the last 3 months
  • optical coherence tomography (OCT), available from optometrist
  • photograph of optic nerve head, available from optometrist, with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate

Clinical management advice

Optic disc swelling may have benign or serious causes but is an important sign and requires urgent assessment by a specialist in the field.

  • Papilloedema is swelling of the optic discs caused by raised intracranial pressure. It is typically bilateral but may be asymmetrical. Vision is not affected unless it is severe or chronic.
  • Pseudo-papilloedema is common and is the appearance of optic disc swelling in healthy people and eyes. Causes can include anatomical variation in the optic nerve head, Drusen (tiny calcium deposits on the optic nerve), hypermetropic eyes and tilted optic discs.
  • Differentiating between papilloedema and pseudo-papilloedema can be difficult and may require thorough investigation and specialist medical input.

Papilloedema may be associated with the following symptoms:

  • headaches – increased severity or frequency, typically worse on waking or when lying down
  • nausea or vomiting
  • binocular double vision
  • transient blurring or blacking out of vision
  • loss of peripheral vision
  • pulsatile tinnitus (whooshing sound in time with the heart-beat)
  • behavioural or cognitive changes
  • seizures

Optic disc swelling associated with acute vision loss is unlikely to be papilloedema. Causes may include inflammation (optic neuritis) or infiltration of the optic nerve.

Clinical 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.