Eye Trauma - 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

• uncomplicated corneal or conjunctival foreign body
• second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• recent blunt trauma with any of the following:
  • abnormal eye movements
  • abnormal intraocular pressure
  • hyphaema
  • pupil changes
  • retinal detachment and/or macular hole
• recent orbital fracture with:
  • diplopia, and/or
  • changes in orbital appearance
• persistent corneal staining or opacity more than 36 hours after removal of foreign body

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 pupil changes
• 12 weeks or more after orbital fracture with any of the following features:
  • persistent diplopia, and/or
  • persistent changes in orbital appearance
  • corneal staining more than 12 weeks after foreign body removal

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
• 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
  • pupillary light reactions and red reflexes
  • slit lamp examination of pupil, anterior chamber, intraocular pressure, if possible
  • fundus examination if possible
• photograph with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate

Clinical management advice

Eye trauma can result from various causes, such as accidents, sports-related injuries, falls, or even intentional harm. Prompt evaluation and appropriate management are essential to prevent further complications and preserve vision.

Clinical resources

• Royal Australian College of General Practitioners - Eye Injuries
• Royal Children's Hospital Melbourne - Trauma Service: Eye injury
• Royal Children's Hospital Melbourne - Acute Eye Injury

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.