Eye Infections / Inflammations

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:

  • Chronic non-severe blepharitis with no corneal or structural lid changes.
  • Chronic dry eye controlled with ocular lubricants.

All referrals should comply to the Standard Referrals guidelines and include in particular:

  • Duration of condition
  • Unilateral or bilateral
  • History of allergic/viral/bacterial conjunctivitis with/out discharge
  • History of contact lens use especially with ulceration
  • History of photophobia or pain
  • History of lid swelling or exophthalmos
  • History of rash especially vesicular
  • History of connective tissue disorders
  • History of foreign body or foreign body sensation
  • Pupil size and reaction to light

Tests

  • Bacterial or viral swab where appropriate
  • Fluoroscein staining for ulceration

Interim/GP management

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

Suspected sub tarsal foreign body: Evert upper lid and remove with cotton bud and check for corneal damage with fluorescein. Refer if unable to remove or if corneal ulceration.

Allergic conjunctivitis: Cessation of allergen. Commence conservative treatment such as lubricants, mast cell stabilisers and/or topical antihistamine. Refer immediately if reduced vision.

Bacterial conjunctivitis: Commence appropriate broad spectrum topical antibiotic for four days. Refer if unresponsive after 4 days or immediately if reduced vision.

Dry eye: Commence regular ocular lubricants. Refer if painful and unresponsive to treatment after 2 weeks. Refer immediately if corneal ulceration or reduced vision.

Blepharitis: Commence lid care and lubricants. Consider course of oral doxycycline if unresponsive. Referral if severe with corneal or structural lid changes. Optometrist or ophthalmologist report required if referral not urgent.

Herpes simplex dendritic ulcer: Commence appropriate topical antiviral. Refer immediately.

For more information please see the Tasmanian Health Pathways website.

Emergency

Emergency - ring on call Ophthalmic Registrar to discuss.

Painful red eye

Red eye or discharging eye with reduced vision

Preseptal and orbital cellulitis

Suspected iritis

Suspected herpes simplex or herpes zoster ophthalmicus

Acute dacrocystitis

Ulcerated, hazy or enlarged cornea

Suspected acute angle closure glaucoma.

Painful red eye with non-responsive mid-dilated pupil

Urgent / category 1

Bacterial conjunctivitis unresponsive to 4 days of broad spectrum topical antibiotics

Drug allergy persisting after removal of allergen

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

Routine / category 3

Allergic eye disease with no loss of vision

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) 6348 7382
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