See resources for referral form, parent information and more.

Pre-referral assessment & treatment

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. Do a pinhole test for visual acuity in the older children (if vision improves, a refractive error is indicated).
3. 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.
4. Perform fundus examination and note presence/absence of red and white reflex.
5. Assess pupillary reactions and sizes.

Initial findings and when to refer

Ages birth - 2 years

• With failure to fix and follow and/or abnormal eye movements
  • IMMEDIATE REFERRAL

Ages 3 - 5 years

• Failed routine screening test with MCHN
  Usually tested at age 3 years 6 months.  Acuity of 6/12 or better is normal.
  • Refer semi-urgently
    
    
• Acute loss of visual acuity
  • IMMEDIATE REFERRAL
    Send child to the Emergency Department if unable to contact the eye clinic.
    Please include with the referral relevant history (eg: length of time of vision loss, surrounding circumstances of vision loss, any accompanying symptoms).

Ages 5 - 9 years

• Failed routine screening test at school
  Tested at ages 5 years to 6 and a half years.  Acuity of 6/9 or better is normal.
  • Refer semi-urgently.
    
    
• Difference of 2 lines or more between eyes 
  • Refer semi-urgently
     

• Decreased acuity in school-age children with developmental delay or autism
  • Refer non-urgently
    

• Acute loss of visual acuity
  • IMMEDIATE REFERRAL
  • Send child to the Emergency Department if unable to contact the eye clinic.
  • Please include with the referral relevant history (eg: length of time of vision loss, surrounding circumstances of vision loss, any accompanying symptoms).

AGES 9+

• Acute loss of visual acuity
  • IMMEDIATE REFERRAL
  • Please send child to the Emergency Department if unable to contact the eye clinic.
  • Please include with the referral relevant history (eg: length of time of vision loss, surrounding circumstances of vision loss, any accompanying symptoms). 
    
    
• Any other referrals for children aged 9+ years
  • Any other referrals for children aged 9+ years with decreased visual acuity (non-acute) are not accepted at the RCH eye clinic.
  • Please refer the child to a local ophthalmologist/optometrist.

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 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.

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.