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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.
- new onset central or branch retinal artery occlusion
- intra ocular pressure (IOP) greater than 35 mmHg
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
Exclusions
- hypertensive retinopathy without visual changes
- hypertensive retinopathy screening in pregnancy
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- all central retinal vein occlusions
- branch retinal vein occlusion with recent decrease in vision
- arteritic anterior ischemic optic neuropathy
Category 2 (appointment clinically indicated within 90 days)
- incidental branch retinal artery occlusion
- incidental retinal arteriole cholesterol embolus (Hollenhorst plaque)
- branch retinal vein occlusion without recent decrease in vision
- non-arteritic anterior ischemic optic neuropathy
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
- smoking/vaping history
- ocular history, including:
- symptoms and duration of clinical presentation
- surgery and medical management, including risk factor management
- 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
- refraction, gonioscopy, pachymetry
- check for corneal epithelial damage with fluorescein
- intra ocular pressure
- relevant social information including:
- employment/education associated implications
- carer for partner/family member
- lives alone, unable to manage daily activities due to vision loss
- optometrist report within 3 months
- photograph with patient’s consent, where secure image transfer, identification and storage is possible where appropriate
Additional information to assist triage categorisation
- investigations required:
- blood pressure trend
- electrocardiogram (ECG) where appropriate
- echocardiogram (ECHO) where appropriate
- optical coherence tomography (OCT)
- bilateral carotid ultrasound (US) (arterial occlusion)
- pathology:
- complete blood examination (CBE)
- urea electrolytes and creatinine (UEC)
- estimated glomerular filtration rate (eGFR)
- glycated haemoglobin (HbA1C) (if diabetic)
- fasting blood glucose results
- fasting lipids results
- erythrocyte sedimentation rate (ESR)
- international normalised ratio (INR)
- activated partial thromboplastin time (APTT)
Clinical management advice
Risk factor management is an important part of the treatment and prevention of retinal artery occlusion. Risk factors may include:
- hypertension
- hypercholesteremia
- diabetes
- smoking/vaping
- cardiovascular disease
- thrombophilic disorders
Clinical resources
- American Academy of Ophthalmology - Retinal artery occlusion
- American Academy of Ophthalmology - Retinal vein occlusion
- NSW Health– Eye emergency app
- HealthPathways SA – Ophthalmology log in required
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.