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.

  • foreign body, either intraocular or central cornea
  • orbital fracture
  • thermal burns to eyelids or eye
  • chemical corneal burns – immediately begin continuous irrigation with water or saline
  • where suspected penetrating injury/globe rupture do not force the eyelid open

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

  • blunt trauma to the eye causing:
    • loss of vision
    • distortion of pupil
    • hyphaemia with possible raised intraocular pressure
    • retinal detachment or
    • ruptured globe
  • penetrating eye injury
  • corneal laceration
  • retrobulbar haemorrhage
  • contact lens related corneal infections for example, bacterial keratitis
  • proptosis, limit eye movements - retrobulbar haematoma
  • enopthalmia (enophthalmos) distorted globe, chemosis, limited movements - globe rupture

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • uncomplicated corneal or conjunctival foreign body
  • recurrent corneal erosion post foreign body removal

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • recent blunt trauma with any of the following:
    • reduced vision
    • hyphaema
    • pupil changes
    • normal intraocular pressure
    • macular hole
    • retinal tears, holes or detachments
  • recent orbital fracture with:
    • diplopia, and/or
    • changes in orbital appearance

Category 2 (appointment clinically indicated within 90 days)

  • 12 weeks or more after blunt trauma injury with any of the following features:
    • history of hyphaema, and/or
    • persistent reduced vision or visual distortion
    • persistent pupil changes
  • 12 weeks or more after orbital fracture with any of the following features:
    • persistent diplopia, and/or
    • persistent changes in orbital appearance

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.

  • relevant past medical/surgical history
  • current medications, allergies

Ocular history

  • symptoms and duration of clinical presentation including:
    • mechanism of injury - possible exposure to foreign body, chemicals or high velocity projectiles. For example, lawn mowers, power tools, motor vehicle accident
    • blurred vision, vision loss, flashing lights/floaters/visual field defect (retinal detachment)
    • diplopia
    • other eye conditions, for example unilateral vision
    • pain, foreign body sensation
    • tearing, discharge, photophobia
    • first aid provided prior to presentation
  • contact lens use
  • surgery and medical management
  • medication management
  • eye and vision examination:
    • best corrected visual acuity
    • slit lamp examination where possible
  • optometrist report, category 2 presentations only
  • photograph with patient’s consent, where secure image transfer, identification and storage is possible where appropriate

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.