OPHTHALMOLOGY DEPARTMENT Primary care referral guidelines Contents REFERRAL CATEGIES... 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. 1 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 CATEGIES 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 () appropriately, based on the following guidelines. Not accepted 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. 2 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 until clinical threshold for referral is reached. Ophthalmological Condition Symptoms Age-related macular degeneration Family history but asymptomatic (AMD) Dry AMD: Asymptomatic drusen and pigmentary changes Cataracts Visual acuity 6/9 or better Blepharitis Itchy eyes No lid or corneal changes Conjunctivitis No other signs or symptoms Chalazion Adult patients will not be accepted Diabetes Newly diagnosed or established for fundus exam (screening) Non proliferative/background diabetic retinopathy Dry eyes Longstanding Entropion/ectropion No corneal involvement or lid irritation Epiphora (watery eye) Intermittent watery Blocked tear ducts See guidelines for accepted threshold Excess eyelid skin Not obscuring line of sight Floaters Longstanding with no other symptoms See Guidelines for accepted threshold Glaucoma Non acute Requiring non urgent/ongoing treatment Itchy eyes Longstanding Pterygium Asymptomatic Red eye No associated visual loss Chronic Refraction For glasses check Refractive laser surgery Retinal Asymptomatic epiretinal membrane (ERM) Trichiasis No corneal involvement Removal of eyelash by community eye care provider 3 Ophthalmology Department Primary Care Referral Guidelines
REFERRAL GUIDELINES Diagnosis Evaluation Investigation Referral Guidelines Age-related macular degeneration (AMD) Cataract Corneal Diabetic eye disease Eye infections Eyelid lesions or malposition Eye pain 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 Lid lesions, droopy lids obstructing vision, ectropion/ entropion Red eye with severe pain Red eye with decreased vision Ophthalmologist/ report required with referral Review by recommended Detailed report from required with referral Consider referral to ophthalmologist privately for assessment if uncertain Ophthalmologist report required with referral Ophthalmologist/ report required with referral Refer to Medical Retina Clinic Refer to Monash Cataract Service if: Visual Acuity 6/12 or less in the worst eye Visual Acuity <6/9 in the better eye and truck/heavy vehicle driver Refer to Medical Retina Clinic Refer to General Eye Clinic 4 Ophthalmology Department Primary Care Referral Guidelines
Glaucoma Ophthalmological headache Retinal disorders Strabismus Trauma Visual disturbance/ vision loss 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 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 Review by recommended Review by recommended Ophthalmologist/ report to be provided with referral Early intervention required, particularly during infancy Refer to Refer to General Eye Clinic Refer to Medical Retina Clinic if unsure of severity Refer to General Eye Clinic Refer to 5 Ophthalmology Department Primary Care Referral Guidelines
Acknowledgements The Royal Victorian Eye & Ear Hospital Primary Care Referral Guidelines - Ophthalmology 2013. The Alfred Referral Guidelines: Ophthalmology 2012. 6 Ophthalmology Department Primary Care Referral Guidelines