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 including:
- headaches
- visual changes
- nausea and vomiting
- seizures
- cognitive changes
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 specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Category 1 (appointment clinically indicated within 30 days)
- confirmed optic disc swelling with optometrist baseline and follow up reports
- optic disc swelling with suspicious symptoms including:
- recent increase in severity or frequency of headaches
- 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
- recent head trauma
- 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
- 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.
- relevant past medical/surgical history including weight
- current medications, allergies
- smoking/vaping history
- ocular history, including:
- symptoms and duration of clinical presentation
- previous trauma if relevant
- surgery and medical management, including glasses and/ or amblyopia therapy
- medication management
- other eye conditions for example, unilateral vision
- eye and vision examination both eyes:
- best corrected visual acuity
- retinal examination
- slit lamp examination where possible
- relevant social information including:
- employment/education associated implications
- carer for partner/family member
- lives alone, unable to manage daily activities due to vision loss
- optical coherence tomography (OCT) and visual field assessment where relevant
- optometrist report within 30 days
- photograph 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 (where transient blurring or blacking out may occur) or chronic. Symptoms may include:
- headache
- nausea and vomiting
- visual changes
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.
Close monitoring is necessary with a 6-week interval for confirmation of diagnosis with a community optometrist.
- assessment should include a review of clinical history, a physical examination, and optical coherence tomography (OCT).
- at 6 weeks, if any progression or deterioration is detected please contact your nearest Ophthalmology service prior to referring to your nearest specialist outpatient service to ensure the referral has been received.
Optic disc swelling associated with acute vision loss is unlikely to be papilloedema, causes may include inflammation (optic neuritis) or vascular event.
Clinical resources
- NSW Health – Eye Emergency Manual: An Illustrated Guide Second Edition
- HealthPathways SA – Ophthalmology
Consumer 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.