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.

  • acute vision loss in one or both eyes
  • acute double vision with other neurological signs such as:
    • facial droop
    • unilateral limb weakness
    • dysarthria (slurred speech)
    • dysphasia (inability to speak)
    • unilateral sensory loss
    • acute onset vertigo (dizziness)
    • acute onset ataxia (impaired balance or coordination)

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

  • acute double vision without other neurological signs
  • acute nystagmus
  • history +/- serological results suggestive of Giant Cell Arteritis (GCA)

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

  • visual disturbance associated with migraine
  • refractive error

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • arteritic anterior ischemic optic neuropathy

Category 2 (appointment clinically indicated within 90 days)

  • central serous chorioretinopathy
  • non-arteritic anterior ischemic optic neuropathy
  • visual disturbance associated with vigorous exercise

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 glasses and/ or amblyopia therapy
    • medication management
    • other eye conditions, for example unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity
    • 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) where possible
  • optometrist report less than 3 months old
  • photograph, with patient’s consent, where secure image transfer, identification and storage is possible where appropriate

Clinical management advice

All cases of Giant Cell Arteritis (GCA) are an emergency, all suspected cases should be discussed with the rheumatology registrar or on call consultant for assessment, triage and advice on initial management.  See Rheumatology Giant Cell Arteritis – Adult CPC for more information.

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.