See resources for referral form, parent information and more.

Recommended pre-referral assessment / treatment

For children presenting with a red or pink eye, please do the following:

1. Obtain a history concentrating on the possibility of ocular trauma, contact lens wear, time course of the redness and the presence of eye pain, itch and discharge.
2. Carefully inspect the eyelids, everting to examine the undersurface.
3. Stain with fluoroscein to check for corneal abrasions or ulcers.

See the clinical practice guidelines for The Acute Red Eye.

See  Acute Eye Injuries in Children or Penetrating Eye Injury for more information.

Initial findings and when to refer

All the following presentations require an immediate referral to ED:

Please fax your referral to 03 9345 5034 (number also on referral form), note URGENT REFERRAL and contact the on-call ophthalmology registrar or fellow.

1. Child complains of pain, photophobia, watery discharge (could denote the presence of a foreign body, corneal ulcer, herpetic ulcer, acute glaucoma).
   
   
2. Dull, aching eye pain (could indicate iritis, scleritis, episcleritis).
   
   
3. Subconjunctival haemorrhage (could denote trauma, vigorous coughing or vomiting).
   
   
4. Focal conjunctival injection or iris injury (caused by trauma).
   
   
5. Purulent discharge (could denote infective conjunctivitis).
   • Treat with eye toilet and topical chloramphencil. 
   • IMMEDIATE REFERRAL if treatment is ineffective.
   • If neonate, after 3 days >3/52 old
     
     
6. Child complains of itchiness, eyelid swelling and redness, watery discharge (could denote allergic conjunctivitis).
   • Treat with antihistamines (oral or topical) and artificial tears prn
   • IMMEDIATE REFERRAL if treatment is ineffective (~2 weeks of treatment).

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 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

• RCH OPD referral form (word)
• Generic parent handout (about RCH pre-referral guidelines)
• Kids Health Info - parent information website
• Paediatric Pharmacopoeia

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 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 and updated August 2011. Please read  Copyright and Disclaimer.