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.

  • foreign body, either intraocular or central cornea
  • orbital fracture
  • thermal burns to eyelids or eye
  • chemical corneal burns – immediately begin continuous irrigation with water or saline
  • where suspected penetrating injury/globe rupture do not force the eyelid open

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

  • blunt trauma to the eye causing:
    • loss of vision
    • distortion of pupil
    • hyphaemia with possible raised intraocular pressure
    • retinal detachment or
    • ruptured globe
  • penetrating eye injury
  • corneal laceration
  • retrobulbar haemorrhage
  • contact lens related corneal infections for example, bacterial keratitis
  • proptosis, limit eye movements - retrobulbar haematoma
  • enopthalmia (enophthalmos) distorted globe, chemosis, limited movements - globe rupture

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.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • uncomplicated corneal or conjunctival foreign body
  • recurrent corneal erosion post foreign body removal

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • recent blunt trauma with any of the following:
    • reduced vision
    • hyphaema
    • pupil changes
    • normal intraocular pressure
    • macular hole
    • retinal tears, holes or detachments
  • recent orbital fracture with:
    • diplopia, and/or
    • changes in orbital appearance

Category 2 (appointment clinically indicated within 90 days)

  • 12 weeks or more after blunt trauma injury with any of the following features:
    • history of hyphaema, and/or
    • persistent reduced vision or visual distortion
    • persistent pupil changes
  • 12 weeks or more after orbital fracture with any of the following features:
    • persistent diplopia, and/or
    • persistent changes in orbital appearance

Category 3 (appointment clinically indicated within 365 days)

  • nil

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

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
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • relevant past medical/surgical history
  • current medications, allergies

ocular history, including:

  • symptoms and duration of clinical presentation including:
    • mechanism of injury - possible exposure to foreign body, chemicals or high velocity projectiles. For example, lawn mowers, power tools, motor vehicle accident
    • blurred vision, vision loss, flashing lights/floaters/visual field defect (retinal detachment)
    • diplopia
    • other eye conditions, for example unilateral vision
    • pain, foreign body sensation
    • tearing, discharge, photophobia
    • first aid provided prior to presentation
  • contact lens use
  • surgery and medical management
  • medication management
  • eye and vision examination:
    • best corrected visual acuity
    • slit lamp examination where possible
  • optometrist report, category 2 presentations only
  • photograph with patient’s consent, where secure image transfer, identification and storage is possible where appropriate