Pterygium

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.

 

NB - in an emergency of any of the following, its advised to arrange immediate transfer to the emergency department.
 

Adult

Retinal artery occulsion

  • Patients with central or branch retinal artery occlusion

Glaucoma

  • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
  • 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 IOP >35mmHg

Adult/paediatric strabismus

  • Sudden onset of any of the following:
    • constant convergent squint (esotropia) or
    • divergent squint (exotropia) or
    • double vision at any age

Other referrals to emergency

  • Sudden severe visual loss e.g. macular or vitreous haemorrhage, retinal detachment or retinal artery occlusion
  • Rubeosis iridis (iris new vessels)
  • Corneal graft rejection
  • Contact lens keratitis, corneal ulcers
  • Uveitis/scleritis
  • Intra ocular pressure (IOP) > 35 mmHg
  • Signs and/or symptoms of retinal detachment
  • Acute injury e.g. trauma, burns, chemical exposure, foreign body
  • Acutely inflamed eye
  • Preseptal/orbital cellulitis - worsening eyelid oedema, erythema and proptosis
  • Ocular signs or symptoms of temporal arteritis
  • Ophthalmology conditions associated with sudden onset neurological signs and/or symptoms e.g. third cranial nerve palsy or optic disc swelling

Paediatric

Leukocoria

  • White red reflex (refer directly by telephone to the on-call ophthalmology registrar)

Anisocoria (unequal pupil size)

  • If acute onset and associated with neurological signs

Chalazion/meibomian cyst

  • Chalazion with an abscess

Reduced visual acuity

  • Sudden severe vision loss in a child

Elevated optic nerve head

  • If neurological anomaly signs (vomiting, abnormal pupils, severe headache)
  • If Retinal haemorrhages or exudates
Useful Management Information

Refer to HealthPathways or local guidelines

Medical management

  • Lubrication/artificial tears
  • Wear protective sunglasses (wrap around style UV400)
  • Update spectacles
  • Consider annual review by private ophthalmologist or optometrist

Patient resources

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • No category 1 criteria
Category 2
(appointment within 90 calendar days)
  • Size - 3mm or greater from limbus to apex and visual axis is threatened and/or dysplasia
Category 3
(appointment within 365 calendar days)
  • Size - 3mm or greater from limbus to apex

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

Without this information the referral will be returned

  • General referral information
  • BCVA (vision with most recent distance spectacles)
  • Ophthalmologist or optometrist report which states size of pterygium from limbus to apex
Additional Referral Information

Private ophthalmologist or optometrist report including VA, refraction and impact of symptoms

Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.

Feedback

To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.