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Ophthalmology (Adult) Referral Access Criteria

Ophthalmology (Adult) Referral Access Criteria

Patient requires immediate (within 7 days) attention
Immediate referrals (patient to be seen within 7 days) should be sent directly to the relevant hospital. Do not send immediate referrals via Central Referral Service (CRS).

Contact the on-call registrar or service to arrange an immediate ophthalmology assessment for:

  • Acutely inflamed eye
    • With pain / photophobia / discharge
      • Unless obviously secondary to chalazion
  • Contact lens keratitis, corneal ulcers
    • H/o contact lens wear with reduced vision or epithelial defect, trauma, pain
  • Corneal graft rejection
    • If seen on examination
  • Glaucoma
    • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
    • Acute angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, ‘rainbows’ around lights, or sluggish pupil reactions)
    • Patients with intraocular pressure (IOP) >35mmHg
    • Patients with elevated intraocular pressure (IOP) of 25-35 with accompanying signs: (e.g. Uveitic glaucoma)
    • Uveitic glaucoma, neovascular, lens related glaucoma, unstable secondary glaucoma
  • Intraocular pressure
    • > 35 mmHg
  • Lid lesions
    • Proven or suspected melanoma
  • Ocular signs or symptoms of giant cell temporal arteritis
    • Temporal tenderness, jaw claudication, blurring of vision
    • Burning or craniofacial pain or tenderness or superficial temporal arteries refer for immediate review.
  • Post ophthalmic surgery suspected endophthalmitis or other complications
    • Recent Hx surgery or intraocular injection
    • Sudden vision loss
    • Sudden onset of pain and/or inflammation
  • Preseptal/orbital cellulitis
    • Worsening eyelid oedema, erythema and proptosis
    • Restricted globe movements/diplopia
  • Retinal artery occlusion
    • Patients with central or branch retinal artery occlusion with sudden loss of vision, requires urgent cardiovascular/neurologic workup with ophthalmic evaluation
  • Retinal vein occlusion
    • All central retinal vein occlusion
    • Branch retinal vein occlusion with recent decrease in vision
  • Rubeosis iridis (iris new vessels)
    • If seen on examination
  • Signs and/or symptoms of retinal detachment
    • Flashing light, floaters, curtain/ waterfall across vision or shadow of missing vision
  • Sudden severe visual loss
    • e.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion
  • Uveitis/scleritis
    • Pain, photophobia, circum-corneal congestion +/- vision loss
To contact the relevant service, please see Clinician Assist WA: Acute Ophthalmology Assessment (external site)
Ophthalmology (adult) conditions with Referral Access Criteria

These conditions are routinely seen by ophthalmology (adult) outpatient services. This is not an exhaustive list of all conditions seen by the outpatient service. Consideration for referral will not be excluded unless the condition is listed on the exclusion list. If the condition you are referring for is not listed, or is unknown, please include details in the body of the referral.

Referrals missing 'mandatory information' with no explanation provided may not be accepted.

Excluded conditions and services

Exclusions

Referral to public ophthalmology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Age related macular degeneration (AMD)
Cataract
  • Patients who do not want surgery will not be accepted
  • No visual acuity criteria, asymptomatic cataract where optical correction is possible
  • See Clinician Assist WA: Cataracts (external site)
Diabetic retinopathy
  • Routine referral for screening and patients with only mild non-proliferative diabetic retinopathy will not be accepted unless the patients is in an area without primary photo screening or local optometrist service.
  • See Clinician Assist WA: Eye Disease Screening in Diabetes (external site)
Glaucoma
Mild dry eyes
Mild ptosis
  • Patients with involutional ptosis who are asymptomatic or do not want surgery will not be accepted.
Minor ocular abnormalities Conditions without any other pathology. Including but not limited to the following:
  • Blepharitis
  • Self-limiting and uncomplicated conjunctivitis
  • Asymptomatic ectropion
  • Asymptomatic epiretinal membrane
  • Asymptomatic epiphora
  • Longstanding floaters with no other symptoms
  • Longstanding itchy eyes
  • Chronic red eye with no associated vision loss
  • Headaches: when reading, migraine/tension headache with no ophthalmic symptoms
Oculoplastic – cosmetic conditions
  • Patients for new prosthetic eye, not requiring socket revision
  • Cosmetic eyelid surgery
Pterygium
  • Patients who are asymptomatic / do not want surgery will not be accepted
  • Removal for cosmetic reasons not accepted
  • See Clinician Assist WA: Pterygium (external site)
Refractive error

Excluded Elective Procedures

 

All elective procedures must meet an identified clinical need to improve the health of the patient. Procedures are not to be performed for cosmetic or other non-medical reasons. Excluded procedures will not be performed unless under exceptional circumstances and where a clear clinical need has been identified. For excluded procedures, the referral must clearly state:

  • that the request is for an excluded procedure
  • the clinical exception reason as to why it should be considered.

Access the WA Elective Surgery Access and Waiting List Management Policy at WA Health Policy Frameworks.

Excluded procedure Exceptional circumstance includes
Blepharoplasty/Reduction of upper or lower eyelid
  • Clinically significant visual impairment
Last reviewed: 14-05-2024

 
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