Download OPHTHALMOLOGY DEPARTMENT Primary care

OPHTHALMOLOGY DEPARTMENT
Primary care referral guidelines
Contents
REFERRAL CATEGORIES ........................................................................................................................ 2
Emergency ............................................................................................................................................ 2
Urgent................................................................................................................................................... 2
Semi urgent/routine ............................................................................................................................. 2
Not accepted ........................................................................................................................................ 2
OPHTHALMOLOGY CONDITIONS NOT ACCEPTED ................................................................................ 3
REFERRAL GUIDELINES ......................................................................................................................... 4
Age-related macular degeneration (AMD) ........................................................................................... 4
Cataract ................................................................................................................................................ 4
Corneal ................................................................................................................................................. 4
Diabetic eye disease ............................................................................................................................. 4
Eye infections ....................................................................................................................................... 4
Eyelid lesions or malposition ................................................................................................................ 4
Eye pain ................................................................................................................................................ 4
Glaucoma.............................................................................................................................................. 5
Ophthalmological headache................................................................................................................. 5
Retinal disorders................................................................................................................................... 5
Strabismus ............................................................................................................................................ 5
Trauma ................................................................................................................................................. 5
Visual disturbance/vision loss .............................................................................................................. 5
Acknowledgements .............................................................................................................................. 6
The referral guidelines identify key clinical threshold required for referral to the Monash Health
Ophthalmology Department. It is not designed to assist with definitive diagnosis.
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Ophthalmology Department Primary Care Referral Guidelines
Monash Health Ophthalmology Department provides outpatients services for acute ophthalmic
problems. The Ophthalmology Department is unable to undertake routine screening of common
ophthalmic conditions, and therefore these conditions should be referred to community eye
healthcare providers (ophthalmologists).
All referrals must include best-corrected visual acuities, symptoms and duration, functional impact
and any relevant investigations. Referrals with insufficient information will be returned to the
referrer.
REFERRAL CATEGORIES
Emergency

A patient whose condition is identified from referral details as having an acute sight or life
threatening condition where immediate medical or surgical intervention is required.

Patients in this category are recommended to be sent to nearest Monash Health emergency
department.

Ophthalmology registrar on call can be contacted for advice via Monash Health switchboard
Ph: 9594 6666.
Urgent

A patient whose condition is identified from referral details as having the potential to
deteriorate quickly to the point it may become an emergency.

Patients in this category are recommended to be sent to nearest Monash Health emergency
department.
Semi urgent/routine

A patient whose condition may be causing discomfort but is unlikely to become a potential
emergency or deteriorate quickly.

Refer to Monash Health or community eye care provider (ophthalmologist/optometrist)
appropriately, based on the following guidlines.
Not accepted
2

Patients whose condition is identified from referral details as requiring primary care, and not
reaching the threshold criteria for the hospital’s specialist services.

All people over 45 years of age should have a regular eye examination with an
ophthalmologist/optometrist.
Ophthalmology Department Primary Care Referral Guidelines
OPHTHALMOLOGY CONDITIONS NOT ACCEPTED
The following conditions are not routinely seen at the Monash Health Ophthalmology Department
and may be appropriately managed by a local ophthalmologist or optometrist until clinical threshold
for referral is reached.
Ophthalmological Condition
Symptoms
Age-related macular degeneration
(AMD)


Cataracts

Family history but asymptomatic
Dry AMD: Asymptomatic drusen and pigmentary
changes
Visual acuity 6/9 or better
Blepharitis
Conjunctivitis



Itchy eyes
No lid or corneal changes
No other signs or symptoms
Diabetes

Dry eyes


Newly diagnosed or established for fundus exam
(screening)
Non proliferative/background diabetic retinopathy
Longstanding
Entropion/ectropion

No corneal involvement or lid irritation
Epiphora (watery eye)




Intermittent watery
Blocked tear ducts
See guidelines for accepted threshold
Not obscuring line of sight
Itchy eyes





Longstanding with no other symptoms
See Guidelines for accepted threshold
Non acute
Requiring non urgent/ongoing treatment
Longstanding
Pterygium

Asymptomatic
Red eye





No associated visual loss
Chronic
For glasses check
Refractive laser surgery
Asymptomatic epiretinal membrane (ERM)


No corneal involvement
Removal of eyelash by community eye care provider
Excess eyelid skin
Floaters
Glaucoma
Refraction
Retinal
Trichiasis
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Ophthalmology Department Primary Care Referral Guidelines
REFERRAL GUIDELINES
Diagnosis
Age-related
macular
degeneration
(AMD)
Evaluation
Investigation
Referral
Guidelines


Ophthalmologist/
optometrist report
required with referral
Refer to Medical
Retina Clinic

Review by
ophthalmologist/
optometrist
recommended
Detailed report from
ophthalmologist/
optometrist required
with referral
Consider referral to
ophthalmologist
privately for
assessment if
uncertain
Refer to Monash
Cataract Service if:
Visual Acuity 6/12 or
less in the worst eye
OR
Visual Acuity <6/9 in
the better eye and
truck/heavy vehicle
driver


Cataract


Corneal
Diabetic eye
disease
Eye infections



Eyelid lesions or
malposition
Eye pain



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Symptoms of
blurred or
distorted central
vision
Likely intervention
required
Referral must
include best
corrected visual
acuity and
refraction of both
eyes
Referral will only
be accepted with
all the necessary
information
Corneal ulcers,
chemical burns
Proliferative
diabetic
retinopathy/
diabetic
maculopathy
requiring
treatment
Serious eye
infection with
symptoms of
redness, pain,
discharge
Infection not
clearing with
chloramphenicol
eye drops
Chalazion, lid
lesions, droopy lids
obstructing vision,
ectropion/
entropion
Red eye with
severe pain
Red eye with
decreased vision


Refer to ED

Ophthalmologist
report required with
referral
Refer to Medical
Retina Clinic
Refer to ED

Ophthalmologist/
optometrist report
required with referral
Ophthalmology Department Primary Care Referral Guidelines
Refer to General Eye
Clinic
Refer to ED
Glaucoma

Red eye with mild
discomfort

Acute angle
closure glaucoma
Symptoms of
sudden onset
ocular pain,
blurring, redness,
cloudy cornea, and
dilated pupil
Headache with
associated ocular
symptoms eg red
eye, epiphora,
proptosis
Retinal
detachment:
symptoms of
sudden onset
floaters/flashes/
reduced vision
ERM/macular
hole/vitreous
haemorrhage/
retinal vein
occlusion etc

Ophthalmological
headache
Retinal disorders



Strabismus
Type of squint/age
of onset to be
specified

Sudden onset
strabismus and/or
sudden onset
diplopia
Major penetrating
injuries, lid trauma,
blunt trauma,
chemical burns
Sudden onset of
vision loss or
abnormal visual
disturbance

Trauma
Visual disturbance/
vision loss
5


Refer to
ophthalmologist/
optometrist
OR
Refer to General Eye
Clinic
Refer to ED

Review by
ophthalmologist/
optometrist
recommended
Refer to ED
Refer to ED



Review by
ophthalmologist/
optometrist
recommended
Ophthalmologist/
optometrist report to
be provided with
referral
Early intervention
required, particularly
during infancy
Ophthalmology Department Primary Care Referral Guidelines
Refer to Medical
Retina Clinic
OR
Refer to ED if unsure
of severity
Refer to General Eye
Clinic
OR
Refer to
ophthalmologist/
optometrist
Refer to ED
Refer to ED
Refer to ED
Acknowledgements
The Royal Victorian Eye & Ear Hospital Primary Care Referral Guidelines - Ophthalmology 2013.
The Alfred Referral Guidelines: Ophthalmology 2012.
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Ophthalmology Department Primary Care Referral Guidelines