Assessment of periorbital injury involving minor scarring or disfigurement fact sheet

Background

Assessment of permanent impairment of a periorbital injury may involve dysfunction or injury to the visual system and scarring/disfigurement. As a result two separate medical assessments may be required. Both these injuries may be assessed together to minimise the number of assessments for claimants.

Medical assessors whose practice area is ophthalmology evaluate permanent impairment resulting from dysfunction or injury to the visual system. This is done using the relevant sections of Chapter 8 of the American Medical Association Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides), and the relevant guidelines issued by the State Insurance Regulatory Authority (SIRA). These medical assessors are approved to assess in accordance with the ophthalmology module.

Medical assessors whose practice area is plastic surgery evaluate permanent impairment resulting from scarring and/or disfigurement. This is done using the relevant sections of Chapter 9 and 13 of the AMA 4 Guides and the current guidelines on the assessment of permanent impairment issued by SIRA. These medical assessors are approved to assess in accordance with the skin module.

Medical assessors whose practice area is ophthalmology have undertaken additional training and gained accreditation in the assessment of permanent impairment of periorbital injuries involving minor scarring/disfigurement.

When will assessment of periorbital injury involving minor scarring/disfigurement be referred to a SIRA appointed ophthalmologist?

Periorbital injury involving minor scarring/disfigurement will only be referred to a medical assessor whose practice area is ophthalmology when there is an associated dysfunction or injury to the visual system that has also been referred for assessment and there are no other injuries to be assessed under the skin module.

Any facial scarring/disfigurement outside the periorbital area must be referred to a medical assessor whose practice area is plastic surgery.

What is the periorbital area?

The periorbital area refers to the area of the face bound by the margins of the bony orbit. It includes:

• eyelids (upper and lower)
• eyebrows
• root of the nose.

What are some of the examples of periorbital injuries which could be referred to an ophthalmologist?

• Periorbital scarring and visual dysfunction or injury when there is no other scarring
• Periorbital fractures and visual dysfunction or injury
• Minor deformity/disfigurement of the eyelid and visual dysfunction or injury
• Periorbital sensory dysfunction and visual dysfunction or injury
• Periorbital motor dysfunction and visual dysfunction or injury
• Enophthalmos (recession of the eyeball within the eye socket) and visual dysfunction or injury
• Exophthalmos (protrusion of the eyeball from the eye socket) and visual dysfunction or injury
• Ptosis (drooping of the eyelid) and visual dysfunction or injury.

The assessment of sensory and/or motor dysfunction could involve injury to the:

• inferior orbital nerve and visual dysfunction or injury
• superior orbital nerve and visual dysfunction or injury.

In relation to the facial nerve, usually these injuries are associated with unilateral facial weakness and should be assessed by a medical assessor accredited in the nervous system module. Ophthalmologists should therefore limit their assessment of facial nerve injuries to the visual effects of the nerve injury unless the only significant impairment is ptosis (drooping of the eyelid). This should be clarified at allocation review.

What periorbital injuries should be referred to an ophthalmologist?

If the injured person has a visual disturbance and:

• only minor periorbital scarring, fractures, deformity/disfigurement; and/or
• only periorbital sensory and/or motor dysfunction

then all these injuries can be referred to the ophthalmologist.

Which periorbital injuries should not be referred to an ophthalmologist?

If the injured person has a visual disturbance and:

• significant periorbital scarring, fractures, deformity/disfigurement; and/or
• scarring, deformity/disfigurement to other areas of the body; and/or
• sensory and/or motor dysfunction to other areas of the body

then only the visual disturbance should be referred to the ophthalmologist. The other injuries should be referred to a medical assessor who is a plastic surgeon and/ or a medical assessor accredited in the nervous system module.

Medical assessors who are ophthalmologists must decline to assess any periorbital scarring which involves tethering, adherence to underlying structures or results in significant deformity/disfigurement or effects activities of daily living (such as the wearing of glasses due to discomfort). These injuries will be referred to a medical assessor whose practice area is plastic surgery.

Allocation to the medical assessor

The parties will be advised of the appointment and details of the referral provided. If at assessment the ophthalmologist medical assessor believes the injury would be best assessed by another specialist medical assessor, they should advise SIRA in the agreed manner. The injury will then be referred to the appropriate medical assessor for assessment.

If either party believes the matter should be referred to another medical assessor for assessment

Either party should contact SIRA and provide reasons and/or supporting documentation as outlined above.