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 including:
    • headaches
    • visual changes
    • nausea and vomiting
    • seizures
    • cognitive changes

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.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • confirmed optic disc swelling with optometrist baseline and follow up reports
  • optic disc swelling with suspicious symptoms including:
    • recent increase in severity or frequency of headaches
    • 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
    • recent head trauma
  • 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
    • 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 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 including weight
  • current medications, allergies
  • smoking/vaping history
  • ocular history, including:
    • symptoms and duration of clinical presentation
    • previous trauma if relevant
    • surgery and medical management, including glasses and/ or amblyopia therapy
    • medication management
    • other eye conditions for example, unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity
    • retinal examination
    • slit lamp examination where possible
  • relevant social information including:
    • employment/education associated implications
    • carer for partner/family member
    • lives alone, unable to manage daily activities due to vision loss
  • optical coherence tomography (OCT) and visual field assessment where relevant
  • optometrist report within 30 days
  • photograph 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 (where transient blurring or blacking out may occur) or chronic. Symptoms may include:

  • headache
  • nausea and vomiting
  • visual changes

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.

Close monitoring is necessary with a 6-week interval for confirmation of diagnosis with a community optometrist.

  • assessment should include a review of clinical history, a physical examination, and optical coherence tomography (OCT).
  • at 6 weeks, if any progression or deterioration is detected please contact your nearest Ophthalmology service prior to referring to your nearest specialist outpatient service to ensure the referral has been received.

Optic disc swelling associated with acute vision loss is unlikely to be papilloedema, causes may include inflammation (optic neuritis) or vascular event.

Clinical resources

Consumer resources