See resources for referral form, parent information and more.

Pre-referral assessment

Please check the following:

1. Check visual acuity if child is of an appropriate age. If the child is too young to check visual acuity, ascertain whether the child can fix and follow - for toddlers try a toy, for infants try a toy or a light.
2. Check ocular motility - ask child to look at the roof, down at the ground, and side-to-side. If child too young, again try a toy or a light.
3. Perform fundus examination and note presence/absence of red and white reflex.
4. Assess pupillary reactions and sizes.
5. Note any behavioural issues (was the child hard to assess, do they have a history of ADHD or autism etc).

Initial findings and when to refer

A: Eye turning in (esotropia)

• Intermittent/variable turning in of the eye before 3 months of age.
  Do not refer - this is normal for infants.
• Intermittent/variable turning in of the eye after 3 months of age.
  Refer semi-urgently for evaluation of strabismus.
• Constant large turning in of the eye before and after 3 months of age.
  Refer semi-urgently for evaluation of strabismus.
• Constant turning in of the eye after 9 years of age (and complaint has been a long-standing problem).
  Refer non-urgently to local ophthalmologist/optometrist.
• True acute onset of constant esotropia at any age.
  IMMEDIATE REFERRAL
  Fax referral to 03 9345 5034 (number also on referral form) and call the on-call ophthalmology registrar/fellow.

B: Eye turning out (exotropia)

• Intermittent/constant turning out of the eye up to the age of 9 years.
  Refer non-urgently.
• Intermittent/constant turning out of the eye after 9 years of age.
  Refer to local optometrist/ophthalmologist.
• True acute onset of constant exotropia.
  IMMEDIATE REFERRAL - ring on-call ophthalmology registrar/fellow.

Contact information

RCH Switchboardtelephone (03) 9345 5522

For clinical advice ask for:

• Ophthalmology registrar or consultant on-call
  • Department of Ophthalmology - clinical advice (or direct dial 03 9345 5630)
  • Emergency Department - for clinical advice after hours

For outpatient bookings fax to 03 9345 5034 (number also on referral form)

• For urgent appointments also call 03 9345 6180

Admission enquiries ask for:

• General admission enquiries (or direct dial 03 9345 6172)
• ED admission enquiries: (or direct dial 03 9345 6477)

Resources

• RCH OPD referral form (word)
• Generic parent handout (about RCH pre-referral guidelines)
• Kids Health Info - parent information website
• Kids Connect (Primary Care Liaison) www.rch.org.au/kidsconnect
  OPD resources for GPs page contains all referral forms, clinic information, referral process information, other pre-referral guidelines, MBS Enhanced Primary Care Items and parent information.
• Paediatric Pharmacopoeia

References

Paediatric Handbook (2009). Eye Conditions, Chapter 23 (pp357-368). James Elder and Peter Barnett. 8th Ed, Blackwell Publishing by the Staff of the Royal Children's Hospital, Melbourne. Australia.

Feedback

Please give feedback on this guideline - kids.connect@rch.org.au / telephone: (03) 9345 4645 / fax (03) 9345 4650

Last updated

Last update: August 2011

Guideline developed by the RCH Department of Ophthalmology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Dec 2007. Reviewed August 2009. Please read  Copyright and Disclaimer.