Uveitis (Red Eye) - 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)

• chronic red eyes with vision loss including:
  • vernal/allergic keratoconjunctivitis
  • blepharitis with conjunctivitis
• screening for chronic anterior uveitis in children with:
  • rheumatological conditions
  • connective tissue disorders
    

Category 2 (appointment clinically indicated within 90 days)

• chronic red eyes unresponsive to conservative management, including
  • vernal/ allergic keratoconjunctivitis
  • blepharitis with conjunctivitis
• chronic red eyes in children following a bone marrow transplant
  

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 therap
  • history of any topical facial medicines or eye drops
• eye and vision examination in both eyes
  • literate children use the visual acuity chart
  • preschool children use the picture or letter matching chart
  • pre-literate children use the visual behaviour e.g. ability to fix and follow an object of interest
• optometrist report within the last 4 weeks
• photograph with patient’s consent, where secure image transfer, identification and storage is possible

Clinical management advice

Outpatient specialist review is not necessary for the most common causes of red eye. It is essential to start treatment for conditions like allergies, conjunctivitis, or dry eye before contemplating a referral for outpatient assessment. It is important to ensure that first-line medical management has been attempted and a therapeutically-endorsed optometrist has conducted a review before considering a referral.

Clinical resources

• American Family Physician - Diagnosis and Management of Red Eye in Primary Care
• Royal Australian College of General Practitioners - Acute Red Eye in Children: A Practical Approach
• The Royal Children’s Hospital Melbourne – Acute red eye
• The Royal Victorian Eye and Ear Hospital - Blepharitis
• Therapeutic Guidelines – Allergic Conjunctivitis Guidelines
  

Consumer resources

• 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.