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.

  • optic disc swelling with neurological features

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

  • severe papilloedema
  • optic disc swelling with vision loss

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected malignancy
  • increased optic disc swelling
  • optic disc swelling with suspicious symptoms including:
    • recent increase in severity or frequency of headaches
    • recent behavioural change in pre-verbal children
    • headaches are positional, worse on lying down
    • waking with headaches
    • associated pulsatile tinnitus (whooshing sound in time with the heart-beat)
    • associated nausea, vomiting, sensitivity to light
    • double vision
  • known craniofacial or neurosurgical condition, with suspicious symptoms, including:
    • changes on neuroimaging to suggest raised intracranial pressure
    • recent increase in severity or frequency of headaches
    • recent behavioural change in pre-verbal children
    • headaches are positional, worse on lying down
    • waking with headaches
    • pulsatile tinnitus (whooshing sound in time with the heart-beat)
    • nausea, vomiting, sensitivity to light
    • double vision

Category 2 (appointment clinically indicated within 90 days)

  • previously diagnosed stable optic disc swelling
  • known craniofacial or neurosurgical condition screening for optic disc swelling

Category 3 (appointment clinically indicated within 365 days)

  • nil

For more on outpatient referrals, see the general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral 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
  • interpreter required
  • antenatal, birth, developmental, medical, family history. Note any developmental or behavioural issues such as autism spectrum disorder (ASD), and attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD)
  • ocular history, including:
    • other eye conditions
    • eye trauma
    • surgery and medical management, including glasses and/ or amblyopia therapy
  • history of headaches
    • recent increase in severity or frequency
    • recent behavioural or cognitive change
    • positional, worse on lying down
    • waking with headaches
    • associated pulsatile tinnitus (whooshing sound in time with the heart-beat)
    • associated nausea, vomiting, sensitivity to light
  • eye and vision examination in both eyes:
    • literate children — visual acuity chart
    • preschool children — picture or letter matching chart
    • literate and preschool children — colour vision
    • pre-literate children
      • visual behaviour e.g. ability to fix and follow an object of interest
      • pupillary light reactions and red reflexes
      • cover/uncover test
      • assessment of ocular motility
  • neurological examination
  • optometrist report within the last 3 months
  • optical coherence tomography (OCT), available from optometrist
  • photograph of optic nerve head, available from optometrist, with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate

Clinical management advice

Optic disc swelling may have benign or serious causes but is an important sign and requires urgent assessment by a specialist in the field.

  • Papilloedema is swelling of the optic discs caused by raised intracranial pressure. It is typically bilateral but may be asymmetrical. Vision is not affected unless it is severe or chronic.
  • Pseudo-papilloedema is common and is the appearance of optic disc swelling in healthy people and eyes. Causes can include anatomical variation in the optic nerve head, Drusen (tiny calcium deposits on the optic nerve), hypermetropic eyes and tilted optic discs.
  • Differentiating between papilloedema and pseudo-papilloedema can be difficult and may require thorough investigation and specialist medical input.

Papilloedema may be associated with the following symptoms:

  • headaches – increased severity or frequency, typically worse on waking or when lying down
  • nausea or vomiting
  • binocular double vision
  • transient blurring or blacking out of vision
  • loss of peripheral vision
  • pulsatile tinnitus (whooshing sound in time with the heart-beat)
  • behavioural or cognitive changes
  • seizures

Optic disc swelling associated with acute vision loss is unlikely to be papilloedema. Causes may include inflammation (optic neuritis) or infiltration of the optic nerve.

Clinical resources