My visit three was postponed so this week has been pretty normal.  Since my last post, I had a few interesting patient experiences and I heard some wonderful stories from other optoms.

One of the things I heard from a colleague was that there exists a strange superstition in one town in the West of Scotland.  Apparently, there’s a whole tradition of people that believe that their eso or exotropias resulted from a fright when they were young.  He had heard people say that, when they were little, a dog barked at them and their eye turned in – or a mouse ran across the floor, they were surprised and their eye turned in.

I was working with our newly qualified optom last week and she had a patient with marginal keratitis (not a contact lens wearer, strangely enough).  Anyway, this big guy in his mid-twenties had come in with a red eye.  “It is really sore,” he said. “I thought it needed moisturised so I thought that I would cry to moisturise it.  And I tried to cry, thinking sad thoughts, but only a tiny tear came out.” Professionalism was stretched to breaking point with that one as we struggled not to giggle – the situation was so absurd and the poor guy looked so dejected at his failure to cry properly.

I fitted a gentleman with multifocal contact lenses a couple of days ago.  During the I&R, he noticed all the little patches of stubble he had missed when he was shaving.  It was quite emotional for him, being able to see that well.  It reminded me of an unexpected side effect of fitting my mother in law with multifocal lenses: she called one day to say that her kettle was filthy (she never put her reading specs on to make tea so she hadn’t seen the kettle clearly for ages).  Anyway, this man wandered out of the shop after the I&R, grinning and exclaiming, “I can SEE!”

I tested a woman in her seventies who had come in to find out if she had cataracts.  All of her friends had them so she wanted to know if she had them too.  Her last eye test was ten years ago and, despite having antimetropia, she was using ready readers and… well, this bit just deserves a paragraph of its own:

Her neighbour had bought some nice, very expensive specs a few years ago and then gone blind.  Anyway, not wanting to waste the expensive specs, my patient had been wearing them.  And they were fine.  And expensive.  So she didn’t need any glasses from us.

Of course, my patient hadn’t brought any of her glasses in with her so I couldn’t test her vision with them.  She did have cataracts but she was 6/6 and wasn’t having any symptoms.

The newly qualified optom and I had an interesting case recently.  A man came in (we’ll call him E) with a sore, weeping eye.  It had happened suddenly (in the space of half an hour).  There was stringy white mucus and the lid was swollen.  It looked like an allergy and, since it was one eye only, it had to be a contact allergy.  We booked him in and asked if he’d come into contact with anything unusual: had he touched his eye after touching something at work? He was adamant that nothing unusual had happened.

He was a patient of ours so we looked out the card and found out that he had Steven Johnson Syndrome.  We knew that it had ocular effects but we weren’t 100% sure of the presentation so Kanski was whipped out.  The pictures in Kanski showed a similar, albeit more severe, ocular presentation so we decided to refer E to the hospital.  During the discussion, it came up that E was having a “flare up” and had a rash on his arm.  The NQ optom got on the phone to the hospital and spoke to the Ophthalmology nurse.  The nurse wasn’t convinced but my colleague really pushed and got E an appointment that evening.  E was hesitant, saying that it was probably nothing, but agreed to attend the hospital, just to make sure.

Anyway, about a week later, E comes into our practice.  He came in to thank us both.  Apparently his eye continued to get worse that evening and when he went to the hospital, they admitted him.  He was a lot better now and was really pleased with us.  I was just happy that he was okay.

I tend to worry about all my patients, especially those I refer.

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