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Diplopia Referral Access Criteria

Diplopia Referral Access Criteria

Referrers should use this page when referring patients to public adult ophthalmology outpatient services for diplopia. 
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.
  • Sudden onset of any of the following: constant convergent squint (esotropia), divergent squint (exotropia), double vision at any age, acute trauma related strabismus, acute esotropia +/or acute leukocoria
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
  • Nil
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).
  • Diplopia or long-standing large angle conspicuous deviation that bothers patient
  • Recent onset deviation           
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, duration and severity 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
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • New onset diplopia associated with thyroid orbitopathy/ cranial nerve palsy +/- or possible neurologic disorder 

Category 2

Appointment within 90 days

  • Long standing diplopia associated with thyroid orbitopathy 

Category 3

Appointment within 365 days

  • No defined category 3 criteria
Exclusions
  • Nil
Useful information

Feedback

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