Trauma

Availability

North South North West Statewide

Pre-referral work-up

History

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

  • Clear description of trauma including mechanism of injury; velocity, penetrating
  • Any suspicion of intraocular or intraorbital foreign body – non/magnetic metal/non-metal
  • History of hitting metal with metal → suspicion of intraocular foreign body
  • Chemical injury: detail chemical involved and mechanism injury

Examination

  • Visual acuity
  • Confrontation visual fields
  • Pupil reaction
  • Corneal or sub tarsal foreign bodies
  • Macroscopic hyphaema
  • Eye movements full or reduced
  • Globe formed
  • Lid or canalicular trauma
  • Acute orbital compartment symptom: tight orbit/pain/reduced vision/afferent pupil defect
    • Requires emergency lateral cantholysis – refer suspected cases in a time-critical manor
  • Chemical injury:
    • Immediately irrigate all chemical injuries with Saline, Hartmann's or water for at least 10 minutes.
    • Requires time-critical referral.
  • Retinal detachments must be considered

Tests

  • X-ray (where appropriate)

Interim/GP management

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

Chemical injury: Immediately irrigate all chemical injuries with Saline, Hartmann's or water for at least 10 minutes. Refer to ED. Refer significant chemical injuries in a time-critical manor.

Suspected penetrating eye injury: Avoid pressure on eyeball. Do not attempt to remove any foreign bodies. Do not instil any topical medication. Cover with a protective shield being careful to place no pressure on orbit or eyeball. Treat any nausea or vomiting prior to transport. Transport in a time-critical manor with head elevated above torso. Keep nil by mouth.

Suspected orbital blow out fracture: Advise patient not to blow nose. Refer to ED.

For more information please see the Tasmanian Health Pathways website.

Emergency

Any significant trauma with lid, orbital and or ocular signs and or symptoms

Known or suspected penetrating eye injury

Acute orbital compartment symptom requires emergency lateral cantholysis – refer supected cases in a time critical manor

Chemical injury: Immediately irrigate all chemical injuries with Saline, Hartmann's or water for at least 10 minutes. Refer significant chemical injuries in a time-critical manor

Known or suspected intraocular foreign body

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