Reduced visual acuity / amblyopia
Disclaimer
These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
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Referral to Emergency Department:
If any of the following are present or suspected, please refer the patient to the Emergency Department (via ambulance if necessary) or seek emergency medical advice if in a remote region.
- Decreased visual acuity in the setting of acute trauma (e.g. burns, chemical exposure, foreign body)
- Decreased visual acuity and suspicion of:
- Periorbital cellulitis
- Orbital cellulitis
- Contact lens keratitis
- Herpes zoster ophthalmicus with eye involvement
- Papilloedema (optic nerve or disc swelling).
Immediately contact on-call registrar or service to arrange an immediate Ophthalmology (Paediatric) assessment (seen within 7 days):
- Suspicion of congenital glaucoma (e.g. enlarged eye(s): with horizontal corneal diameter >12.0mm, cloudy cornea, photosensitive, tearing)
- Keratoconus with suspected hydrops or graft rejection
- New cataract for child aged < 3 years
- Leukocoria (absent red reflex) - absent, dull, shadows, or asymmetrical results on red reflex test
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Introduction
Reduced visual acuity in children can be a sign of various eye conditions, including refractive errors, amblyopia, and other ocular pathologies.
Pre-referral investigations
- Examination
- For children aged ≥ 5 years: best corrected visual acuity
Pre-referral management
When to refer
- Visual response or behaviour not aligned with age-expected response where best corrected visual acuity (BCVA) cannot be measured
- Visual acuity (VA) worse than:
- Keratoconus
- Cataracts – confirmed, suspected
- Amblyopia
How to refer
- Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
- Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals are made via the PCH Referral Office (Fax: 6456 0097 or email PCH.Referrals@health.wa.gov.au)
- Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the relevant speciality registrar.
Essential information to include in your referral
- Relevant history, onset, duration, and severity of symptoms
- Details of any family history of visual impairment
- Details of previous treatment and outcome
- Current medication list
- Any known allergies
Useful resources
| Reviewer/Team: |
Ophthalmology Department, PCH |
Last reviewed: |
May 2026 |
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