Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute onset strabismus with associated neurological features

For the following symptoms, contact the ophthalmology registrar prior to referring to the emergency department:

  • acute onset strabismus, without associated neurological signs as this may be associated with changes in pupil or eyelid position
  • strabismus under age 3 with absent or white/red reflex
  • binocular diplopia

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • intermittent/variable strabismus in infants less than 3 months of age (normal)
  • second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • infants under 3 months of age with persistent strabismus

Category 2 (appointment clinically indicated within 90 days)

  • pre-literate child age over 3 months with any strabismus
  • literate child with loss of monocular or binocular visual function

Category 3 (appointment clinically indicated within 365 days)

  • literate child with strabismus and normal vision

For more on outpatient referrals, see the general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • antenatal, birth, developmental, medical, family history. Note any developmental or behavioural issues such as autism spectrum disorder (ASD), and attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD)
  • history of strabismus
    • acute v longstanding
    • intermittent v constant
    • unilateral v alternating
    • horizontal v vertical
    • convergent v divergent
    • associated features e.g. ptosis, abnormal head posture
  • ocular history, including:
    • other eye conditions
    • eye trauma
    • surgery and medical management, including glasses and/ or amblyopia therapy
  • eye and vision examination in both eyes:
    • check for pupillary red reflexes
    • cover or corneal light reflex test for strabismus
    • ocular motility, ask child to follow a toy or a light in all directions of gaze
    • stereo-acuity if possible
    • objective refraction, preferably with cycloplegia, if possible
    • fundus examination if possible
    • literate children — visual acuity chart
    • pre-literate children — visual behaviour e.g. ability to fix and follow an object of interest
    • preschool children — picture or letter matching chart, preferably with crowding
  • optometrist report within the last 3 months for - category 2/3 only
  • photograph with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate in primary gaze and for different positions of ocular motility

Clinical management advice

Referring young children with strabismus at an earlier stage can lead to improved treatment outcomes. It is advisable to consider referring any child presenting with strabismus. For babies under 6 months of age who have intermittent strabismus, it may be appropriate to monitor their condition for spontaneous resolution.

Clinical resources

Consumer resources