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 neurological symptoms which could be attributed to stroke or transient ischaemic attack (TIA) including:
- 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)
- acute onset diplopia (double vision). For sudden onset ptosis please assess and exclude acute neurological event including stroke or TIA prior to referring and consider contacting on-call stroke or neurology service.
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
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Exclusions
- dry eyes
- cosmetic concerns
- excess or saggy eyelid skin that does not affect visual fields
- ectropion with infective keratitis/entropion, refer to ophthalmology
Triage categories
Category 1 - appointment clinically indicated within 30 days
- suspected malignancy
- ectropion with incomplete eye closure leading to corneal irritation
- sudden onset of ptosis
Category 2 — appointment clinically indicated within 90 days
- symptomatic ptosis involving visual axis
Category 3 — appointment clinically indicated within 365 days
- blepharoplasty – excess or saggy upper eyelid skin affecting visual fields
- asymptomatic ptosis involving visual axis
- symptomatic ectropion
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.
- past medical/surgical history
- current medications and dosages
- allergies and sensitivities
- presenting symptoms
- management history including:
- injury/trauma if relevant
- onset and duration
- severity
- pain
- associated features, e.g. functional impairment, visual impairment
Clinical management advice
Please note that eye referrals can be managed by the following specialist services:
- ophthalmology
- plastic surgery
It is strongly recommended that people who smoke or vape stop 3 months prior to consultation. Smoking/vaping is associated with delayed healing. Please refer to useful resources section for further information.
If the patient requires urgent attention and/or fulfils category 1 triage criteria, please contact the on-call registrar to discuss and ensure your referral has been received.
Clinical resources
- HealthPathways SA - Eye Examination in Adults
- Review of Optometry – The OD’s Guide to Ptosis Workshop
- Central Adelaide Local Health Network – PreHab: Getting Ready for Surgery
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.