Primary Care Liaison

Decreased visual acuity

  • See resources for referral form, parent information and more.

    Pre-referral assessment & treatment

    1. Check visual acuity if child is of an appropriate age. If the child is too young to check visual acuity, ascertain whether the child can fix and follow - for toddlers try a toy, for infants try a toy or a light.
    2. Do a pinhole test for visual acuity in the older children (if vision improves, a refractive error is indicated).
    3. Check ocular motility - ask child to look at the roof, down at the ground, and side-to-side. If child too young, again try a toy or a light.
    4. Perform fundus examination and note presence/absence of red and white reflex.
    5. Assess pupillary reactions and sizes.

    Initial findings and when to refer

    Ages birth - 2 years

    • With failure to fix and follow and/or abnormal eye movements
      • IMMEDIATE REFERRAL

    Ages 3 - 5 years

    • Failed routine screening test with MCHN
      Usually tested at age 3 years 6 months.  Acuity of 6/12 or better is normal.
      • Refer semi-urgently

    • Acute loss of visual acuity
      • IMMEDIATE REFERRAL
        Send child to the Emergency Department if unable to contact the eye clinic.
        Please include with the referral relevant history (eg: length of time of vision loss, surrounding circumstances of vision loss, any accompanying symptoms).

    Ages 5 - 9 years

    • Failed routine screening test at school
      Tested at ages 5 years to 6 and a half years.  Acuity of 6/9 or better is normal.
      • Refer semi-urgently.

    • Difference of 2 lines or more between eyes 
      • Refer semi-urgently
         
    • Decreased acuity in school-age children with developmental delay or autism
      • Refer non-urgently
    • Acute loss of visual acuity
      • IMMEDIATE REFERRAL
      • Send child to the Emergency Department if unable to contact the eye clinic.
      • Please include with the referral relevant history (eg: length of time of vision loss, surrounding circumstances of vision loss, any accompanying symptoms).

    AGES 9+

    • Acute loss of visual acuity
      • IMMEDIATE REFERRAL
      • Please send child to the Emergency Department if unable to contact the eye clinic.
      • Please include with the referral relevant history (eg: length of time of vision loss, surrounding circumstances of vision loss, any accompanying symptoms). 

    • Any other referrals for children aged 9+ years
      • Any other referrals for children aged 9+ years with decreased visual acuity (non-acute) are not accepted at the RCH eye clinic.
      • Please refer the child to a local ophthalmologist/optometrist.

    Contact information

    RCH Switchboardtelephone (03) 9345 5522

    For clinical advice ask for:

    • Ophthalmology registrar or consultant on-call
      • Department of Ophthalmology - clinical advice (or direct dial 03 9345 5630)
      • Emergency Department - for clinical advice after hours
    For outpatient bookings fax to 03 9345 5034 (number also on referral form)
    • For urgent appointments also call 03 9345 6180

    Admission enquiries ask for:

    • General admission enquiries (or direct dial 03 9345 6172)
    • ED admission enquiries: (or direct dial 03 9345 6477)

    Resources

    References

    Paediatric Handbook (2009). Eye Conditions, Chapter 23 (pp357-368). James Elder and Peter Barnett. 8th Ed, Blackwell Publishing by the Staff of the Royal Children's Hospital, Melbourne. Australia.

    Feedback

    Please give feedback on this guideline - kids.connect@rch.org.au / telephone: (03) 9345 4645 / fax (03) 9345 4650

    Last updated

    Last update: August 2011

    Guideline developed by the RCH Department of Ophthalmology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Dec 2007. Reviewed August 2009. Please read  Copyright and Disclaimer.