Paediatric ophthalmology

Availability

North South North West Statewide

Pre-referral work-up

History

The following conditions are not routinely seen at the RHH Eye Clinic and may be appropriately managed by the general practitioner, local ophthalmologist or optometrist:

  • Chalazion: without a trial of three months of conservative treatment (gentle heat and massage)
  • Uncomplicated nasolacrimal duct obstruction where infant less than one year of age as most spontaneously resolve

All referrals should comply with the Standard Referral guidelines and include in particular:

  • Visual acuity: Refer all children less than 10 years with reduction in vision of one or both eyes.
  • Red reflex: any white pupil reflex in children, any asymmetric red reflex
  • Congenital glaucoma: Infant with epiphora, photophobia, and blepharospasm
    • May have enlarged or cloudy cornea or corneas
    • May have a positive family history
  • Strabismus: Exotropia or esotropia
    • Constant or intermittent
    • Alternating or not; can either eye take up fixation
    • Objection to cover of either eye
    • Eye movements
  • Anisometropia where known (significant refractive difference between the eyes)
  • Amblyopia: reduced visual acuity, objection to cover of one eye
  • Ptosis: obscuring the line of sight or not
  • Comorbidities: developmental, neurological and/or other problems
  • Suspected vernal catarrh (a form of allergic conjunctivitis in a younger age group) with severe itch, stringy mucoid discharge and marked conjunctival thickening/cobblestone appearance
  • Infantile nasolacrimal duct obstruction: Duration and age of onset
    • Associated episodes of conjunctivitis or dacrocystitis

Interim/GP management

To refer a patient with this condition, please see the Ophthalmology clinic page for the full referral process and templates.

Four year old vision check: All children should have an appropriate vision check at this age. They need to be referred to the RHH Eye Clinic if they have reduction in vision in one or both eyes.

Nasolacrimal dust obstruction: Observe infant with uncomplicated nasolacrimal duct obstruction where infant less than one year of age as most spontaneously resolve.

Chalazion: trial of three months of conservative treatment (gentle heat and massage) prior to referral.

For more information please see the Tasmanian Health Pathways website.

Emergency

Emergency - ring on call Ophthalmic Registrar to discuss.

Infant with epiphora, photophobia, and blepharospasm or suspicion of congenital glaucoma

Enlarged or cloudy cornea or corneas

Painful red eye

Sudden loss of or reduction in vision

Sudden onset ptosis or diplopia or ocular misalignment

Suspected papilloedema or raised intracranial pressure

White pupil reflex in children

Urgent / category 1

Reduced vision in amblyogenic age group

Children with amblyogenic conditions under the age of 10

Ptosis in children under 10

Suspected vernal catarrh (a form of allergic conjunctivitis in a younger age group) with severe itch, stringy mucoid discharge and marked conjunctival thickening/cobblestone appearance

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within ten days, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment