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Ptosis

ADULT

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.


NB - in an emergency of any of the following, its advised to arrange immediate transfer to the emergency department.

Adult

Retinal artery occulsion

  • Patients with central or branch retinal artery occlusion

Glaucoma

  • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
  • Angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, ‘rainbows’ around lights, or sluggish pupil reactions)
  • Patients with IOP >35mmHg

Adult/paediatric strabismus

  • Sudden onset of any of the following:
    • constant convergent squint (esotropia) or
    • divergent squint (exotropia) or
    • double vision at any age

Other referrals to emergency

  • Sudden severe visual loss e.g. macular or vitreous haemorrhage, retinal detachment or retinal artery occlusion
  • Rubeosis iridis (iris new vessels)
  • Corneal graft rejection
  • Contact lens keratitis, corneal ulcers
  • Uveitis/scleritis
  • Intra ocular pressure (IOP) > 35 mmHg
  • Signs and/or symptoms of retinal detachment
  • Acute injury e.g. trauma, burns, chemical exposure, foreign body
  • Acutely inflamed eye
  • Preseptal/orbital cellulitis - worsening eyelid oedema, erythema and proptosis
  • Ocular signs or symptoms of temporal arteritis
  • Ophthalmology conditions associated with sudden onset neurological signs and/or symptoms e.g. third cranial nerve palsy or optic disc swelling

Paediatric

Leukocoria

  • White red reflex (refer directly by telephone to the on-call ophthalmology registrar)

Anisocoria (unequal pupil size)

  • If acute onset and associated with neurological signs

Chalazion/meibomian cyst

  • Chalazion with an abscess

Reduced visual acuity

  • Sudden severe vision loss in a child

Elevated optic nerve head

  • If neurological anomaly signs (vomiting, abnormal pupils, severe headache)
  • If Retinal haemorrhages or exudates

 

 

 

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • No category 1 criteria
  • Category 2
    (appointment within 90 calendar days)
    • Symptomatic ptosis involving visual axis
  • Category 3
    (appointment within 365 calendar days)
    • Symptomatic ptosis not involving visual axis

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • BCVA (vision with most recent distance spectacles)

3. Additional referral information Useful for processing the referral

  • Private ophthalmologist or optometrist report including VA, refraction and impact of symptoms (highly desirable)

4. Request

Patient's 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

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

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.)
  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • 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.