Ophthalmology referral criteria – Adult

Immediate ophthalmology referrals

Immediate referrals (seen within 7 days) are not handled by the Central Referral Service (CRS).

Do not send immediate referrals via CRS – send referrals for patients requiring immediate review (within the next 7 days) directly to the relevant hospital.

Immediately contact the on-call registrar or service to arrange an immediate ophthalmology assessment for:

Presenting Issue Details
Acutely inflamed eye
  • With pain / photophobia / discharge
  • Unless obviously secondary to chalazion
Contact lens keratitis, corneal ulcers
  • H/o contact lens wear with reduced vision or epithelial defect, trauma, pain
Corneal graft rejection
  • If seen on examination
  • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
  • Acute angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, ‘rainbows’ around lights, or sluggish pupil reactions)
  • Patients with intraocular pressure (IOP) >35mmHg
  • Patients with elevated intraocular pressure (IOP) of 25-35 with accompanying signs: (e.g. Uveitic glaucoma)
  • Uveitic glaucoma, neovascular, lens related glaucoma, unstable secondary glaucoma
Intraocular pressure
  • > 35 mmHg
Lid lesions
  • Proven or suspected melanoma
Ocular signs or symptoms of giant cell temporal arteritis
Post ophthalmic surgery suspected endophthalmitis or other complications
  • Recent Hx surgery or intraocular injection
  • Sudden vision loss
  • Sudden onset of pain and/or inflammation
Preseptal/orbital cellulitis
  • Worsening eyelid oedema, erythema and proptosis
  • Restricted globe movements/diplopia
Retinal artery occlusion
  • Patients with central or branch retinal artery occlusion with sudden loss of vision, requires urgent cardiovascular/neurologic workup with ophthalmic evaluation
Retinal vein occlusion
  • All central retinal vein occlusion
  • Branch retinal vein occlusion with recent decrease in vision
Rubeosis iridis (iris new vessels)
  • If seen on examination
Signs and/or symptoms of retinal detachment
  • Flashing light, floaters, curtain/ waterfall across vision or shadow of missing vision
  • Acute onset of diplopia or strabismus
  • Sudden onset of any of the following:
    • Constant convergent squint (esotropia) or
    • Divergent squint (exotropia) or
    • Double vision at any age
    • Acute trauma related strabismus
  • Acute esotropia +/or acute leukocoria in paediatrics
Sudden severe visual loss
  • e.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion
  • Pain, photophobia, circum-corneal congestion +/- vision loss

To contact the relevant service, please see HealthPathways: Acute Ophthalmology Assessment

Excluded ophthalmology services

The WA Elective Surgery Access and Waiting List Management Policy states that all elective procedures performed in the WA health system must meet an identified clinical need to improve the health of the patient. Procedures are not to be performed for cosmetic or other non-medical reasons.

Out of scope / excluded procedures:

  • Blepharoplasty/Reduction of upper or lower eyelid – unless clinically significant visual impairment
  • Blepharitis
  • Itchy eyes
  • Self-limiting conjunctivitis
  • Red eyes without other symptoms 

Referral to public ophthalmology outpatient services is not routinely accepted for the following conditions

Condition Details (where applicable)
Age related macular degeneration (AMD)
  • Dry AMD is not routinely seen unless the practitioner is concerned about progression to wet AMD
  • Please refer to the following HealthPathways: Macular Disease
  • Patients who do not want surgery will not be accepted
  • No visual acuity criteria, asymptomatic cataract where optical correction is possible
  • Please refer to the following HealthPathways: Cataracts
Diabetic retinopathy
  • Routine referral for screening and patients with only mild non-proliferative diabetic retinopathy will not be accepted unless the patients is in an area without primary photo screening or local optometrist service.
  • hyperglycaemic state and without primary photo screening or local optometrist service.
  • Please refer to the following HealthPathways: Eye Disease Screening in Diabetes
Mild dry eyes
Mild ptosis
  • Patients with involutional ptosis who are asymptomatic or do not want surgery will not be accepted.
Minor ocular abnormalities Conditions without any other pathology. Including but not limited to the following:
  • Blepharitis
  • Self-limiting and uncomplicated conjunctivitis
  • Asymptomatic ectropion
  • Asymptomatic epiretinal membrane
  • Asymptomatic epiphora
  • Longstanding floaters with no other symptoms
  • Longstanding itchy eyes
  • Chronic red eye with no associated vision loss
  • Headaches: when reading, migraine/tension headache with no ophthalmic symptoms
Oculoplastic – cosmetic conditions
  • Patients for new prosthetic eye, not requiring socket revision
  • Cosmetic eyelid surgery
  • Patients who are asymptomatic / do not want surgery will not be accepted
  • Removal for cosmetic reasons not accepted
  • Please refer to the following HealthPathways: Pterygium
Refractive error
Last reviewed: 29-05-2023