Ophthalmology Referrals

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the Emergency Department or seek emergent advice if in a remote area.

  • Acute injury; e.g.
    • Trauma
    • Burns
    • Chemical exposure
    • Foreign body
  • Strabismus
    • Acute onset of diplopia or strabismus
    • Sudden onset of any of the following:
      • Constant convergent squint (esotropia) or
      • Divergent squint (exotropia) or
      • Double vision at any age
      • Acute trauma related strabismus
  • Ophthalmology conditions associated with sudden onset neurological signs and/or symptoms; e.g.
    • Diplopia or vision loss with other neurological signs or symptoms
    • Cranial nerve palsies, optic neuropathies, papilledema

Condition:

Details (where applicable):

Age related macular degeneration (AMD)
  • Dry AMD is not routinely seen unless the practitioner is concerned about progression to wet AMD
  • Please refer to the following HealthPathways: Macular Disease

Cataract
  • Patients who do not want surgery will not be accepted
  • No visual acuity criteria, asymptomatic cataract where optical correction is possible
  • Please refer to the following HealthPathways: Cataracts

Diabetic retinopathy
  • Routine referral for screening and patients with only mild non-proliferative diabetic retinopathy will not be accepted unless in those in hyperosmolar hyperglycaemic state and without primary photo screening or local optometrist service.
  • Please refer to the following HealthPathways: Eye Disease Screening in Diabetes

Glaucoma

Mild dry eyes

Minor ocular abnormalities

Conditions without any other pathology. Including but not limited to the following:

  • Blepharitis
  • Mild dry eyes
  • 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

Pterygium
  • Patients who are asymptomatic / do not want surgery will not be accepted
  • Removal for cosmetic reasons not accepted
  • Please refer to the following HealthPathways: Pterygium

Refractive error
  • Prescription of spectacles in patients older than 12 years
  • Presbyopia
  • Patients requiring supply of optical devices +/- or contact lenses
  • Please refer to the following HealthPathways: Refractive Error

To arrange an urgent review or advice, please phone the RPH switchboard on 9224 2244 and ask to speak with the on-call registrar for Ophthalmology.

After verbal clinical handover and agreement with the registrar that the patient requires an appointment with RPH within 7 days please email the patient’s referral to:

RPH, Central Referral Receipting RPH.OutpatientReferrals@health.wa.gov.au

Ensure the referral is:

  • marked IMMEDIATE
  • the name of the registrar or consultant spoken with is written on the referral
  • all essential referral information, investigations, clinical photos are included

IMMEDIATE (Appointment within 7 days):

Presenting Issue

Details

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: (Uveitic glaucoma, etc.)
  • Uveitic glaucoma, neovascular, lens related glaucoma, unstable secondary glaucoma

Intraocular pressure
  • >35mmHg

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 for immediate review

 

To contact the relevant service, please refer to Acute Rheumatology Assessment (seen within 7 days) - Community HealthPathways Western Australia

Post ophthalmic surgery / Rx endophtalmitis
  • Recent Hx surgery
  • Injection
  • Sudden vision loss
  • Sudden onset of pain

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

Strabismus
  • Acute onset of diplopia or strabismus
  • Sudden onset of any of the following:
    • Constant convergent squint (esotropia) or
    • Divergent squint (extropia) or
    • Double vision at any age
    • Acute trauma related strabismus
  • Acute estotropia +/- or acute leukocoria in paediatrics

Sudden severe visual loss
  • E.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion

Uveitis/scleritis
  • Pain, photophobia, circum-corneal congestion +/- vision loss

 

Referrals will be returned without this information

  • visual acuity
  • intra-ocular pressure
  • pertinent anterior segment, retinal and optic nerve features
  • visual field test if relevant
  • ophthalmic history.

Please include photographs with your referral where possible

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the referral.

Minimum Standard Referral is included in the standard referral template Referral-form-templates and is available Minimum-standards-for-outpatient-referrals-Central-Referral-Service

Please ensure patient email and mobile phone numbers are included to facilitate patient contact.

Patients can be flagged for Video or Telephone consultations at referral, triage or follow-up.

With a high demand for new, non-urgent Eye Clinic appointments at RPH, the Department of Ophthalmology requests that GPs consider directing patients to see an optometrist (if they haven’t already). Where referral to RPH is still required, please include a copy of the optometrist’s report with the referral.

Key points which optometrists can provide to help with triage are:

  • visual acuity
  • intra-ocular pressure
  • pertinent anterior segment, retinal and optic nerve features
  • visual field test if relevant
  • ophthalmic history.

Please Note: Ophthalmology has an extensive outpatient waitlist for routine referrals. Consider alternate referral pathways such as:

  • Referral to a private or community provider.

 

Named referrals for Ophthalmology will be allocated a suitably qualified specialist to see the patient, noting these referrals are booked based on first on, first off principles from the outpatient waitlist

Please note that where appropriate and where available, Ophthalmology referrals may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

 

The following are not routinely provided in a public Ophthalmology service.

Exclusion Criteria:

  • Blepharoplasty/Reduction of upper or lower eyelid – unless clinically significant visual impairment
  • Blepharitis
  • Itchy eyes
  • Self-limiting conjunctivitis
  • Red eyes without other symptoms

Condition

Details (where applicable)

Age related macular degeneration (AMD)
  • Dry AMD is not routinely seen unless the practitioner is concerned about progression to wet AMD

Cataract
  • Patients who do not want surgery will not be accepted
  • No visual acuity criteria, asymptomatic cataract where optical correction is possible

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.
  • hyperglycaemic state and without primary photo screening or local optometrist service.

Glaucoma
  • Patients with stable mild glaucoma should be managed in the community

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

Refractive error
  • Presbyopia
  • Patients requiring supply of optical devices +/- or contact lenses

While the WA Health Excluded Procedures precludes procedures performed for cosmetic or other non-medical reasons, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals.

To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at Royal Perth Hospital, referral criteria have been established for abdominal lipectomy, breast reduction, blepharoplasty, male circumcision, rhinoplasty and varicose veins.

Visit the Royal Perth Hospital - Excluded Procedures Outpatient Referrals (health.wa.gov.au) page for more information.

The following are not routinely provided in a public Ophthalmology service.

EMHS is responsible for providing public health services to the people who reside within its boundaries. 

The emhs-catchment-map.pdf (health.wa.gov.au) outlines the suburb catchment areas for East Metropolitan Health Service (EMHS). The country areas that flow to EMHS are Kimberley, Pilbara and Wheatbelt.

Referral to a hospital for assessment and/or treatment is based around multiple criteria. These include:

  • Place of residence – most hospitals have catchments to help service people closer to home. For country patients, the residence of family with whom they will reside whilst attending appointments can be taken into consideration.
  • Age – RPH is an Adult Hospital, children are only treated by some hospitals.
  • Hospital location of specialty services – some conditions need designated specialist services that are not available at all hospitals.

Please use this information to guide referrals to the hospital servicing your patient's residence and inform your patients of these criteria when you are referring them for public hospital services via the Central Referral Service (CRS).

Last Updated: 13/09/2023