Acute onset or progressive blurred vision Referral Access Criteria

Referrers should use this page when referring patients to public adult ophthalmology outpatient services for acute onset or progressive blurred vision.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Acute injury e.g. trauma, burns, chemical exposure, foreign body Ophthalmology conditions associated with sudden onset neurological signs and/or symptoms – diplopia or vision loss with other neurological signs or symptoms, cranial nerve palsies, optic neuropathies, papilledema

Immediate referral
Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
Post ophthalmic surgery suspected endophthalmitis or other complications – recent Hx surgery or intraocular injection, sudden vision loss, or sudden onset of pain and/or inflammation Ocular signs or symptoms of giant cell temporal arteritis – temporal tenderness, jaw claudication, blurring of vision, burning or craniofacial pain or tenderness of superficial temporal arteries (consider immediate high dose steroids) Retinal artery occlusion – patients with central or branch retinal artery occlusion Sudden severe visual loss e.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion Corneal graft rejection – if seen on examination Contact lens keratitis, corneal ulcers – H/o contact lens wear with reduced vision or epithelial defect, trauma, pain Uveitis/scleritis – pain, photophobia, circum-corneal congestion +/- vision loss Intraocular pressure (IOP) > 35 mmHg Signs/symptoms of retinal detachment – flashing lights, floaters, curtain/waterfall across vision or shadow of missing vision Acutely inflamed eye – with pain/photophobia/discharge (unless obviously secondary to chalazion) Preseptal/orbital cellulitis – worsening eyelid oedema, erythema and proptosis, restricted globe movements/diplopia To contact the relevant service, see Clinician Assist WA: Acute Ophthalmology Assessment (external site)

Immediate referral

Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):

Post ophthalmic surgery suspected endophthalmitis or other complications – recent Hx surgery or intraocular injection, sudden vision loss, or sudden onset of pain and/or inflammation
Ocular signs or symptoms of giant cell temporal arteritis – temporal tenderness, jaw claudication, blurring of vision, burning or craniofacial pain or tenderness of superficial temporal arteries (consider immediate high dose steroids)
Retinal artery occlusion – patients with central or branch retinal artery occlusion
Sudden severe visual loss e.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion
Corneal graft rejection – if seen on examination
Contact lens keratitis, corneal ulcers – H/o contact lens wear with reduced vision or epithelial defect, trauma, pain
Uveitis/scleritis – pain, photophobia, circum-corneal congestion +/- vision loss
Intraocular pressure (IOP) > 35 mmHg
Signs/symptoms of retinal detachment – flashing lights, floaters, curtain/waterfall across vision or shadow of missing vision
Acutely inflamed eye – with pain/photophobia/discharge (unless obviously secondary to chalazion)
Preseptal/orbital cellulitis – worsening eyelid oedema, erythema and proptosis, restricted globe movements/diplopia

To contact the relevant service, see Clinician Assist WA: Acute Ophthalmology Assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Blurred central vision Macular hole diagnosed by optometrist/ophthalmologist

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Relevant history, onset and duration of symptoms Details of previous treatment and outcome
Examination	Best corrected visual acuity (BCVA) - vision with most recent distance spectacles
Investigations	Nil

Highly desirable
History	Nil
Examination	Nil
Investigations	Most recent optometrist or private ophthalmologist report including: Refraction Impact of symptoms Optical coherence tomography (OCT)

Indicative clinical urgency category
Category 1 Appointment within 30 days	Full thickness of macular hole
Category 2 Appointment within 90 days	Vitreomacular traction with/without impending macular hole Lamellar macular hole with BCVA worse than 6/12
Category 3 Appointment within 365 days	Lamellar macular hole with BCVA of 6/12 or better

Indicative clinical urgency category

Category 1

Appointment within 30 days

Full thickness of macular hole

Category 2

Appointment within 90 days

Vitreomacular traction with/without impending macular hole
Lamellar macular hole with BCVA worse than 6/12

Category 3

Appointment within 365 days

Lamellar macular hole with BCVA of 6/12 or better

Exclusions
Nil

Useful information
See Clinician Assist WA: Sudden Loss of Vision (external site) For optometry requests see Clinician Assist WA: Optometry Requests (external site)

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Acute onset or progressive blurred vision Referral Access Criteria

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