In my previous blog, I mentioned the amount of pathology that I’m seeing in my new practice.  This last week, I’ve probably seen more rare and interesting things than in my entire pre-reg.  I’ll give you a brief summary of the highlights:

1) 17 year old with Duane’s, right eye affected.  She told me she had it during Hx so I wasn’t too phased when I did motility.

2) 37 year old with cellophane maculopathy (R&L) who woke up with monocular diplopia.

3) 65 year old who told me that when he was a boy, he saw an eye specialist who told him that he had something very rare in one of his eyes (but he couldn’t remember what it was or which eye).  This turned out to be the most beautiful cataract I’d ever seen.  It was a Christmas tree cataract and it was actually shaped like a Christmas tree (it was triangular and started wide inferiorly and came to a tip at the centre of the lens).  It looked like tinsel and had reds, yellows and greens in it.  I told the man that he did indeed have something rare (and very beautiful) in his eye and promptly showed him a picture of an inferior Christmas tree cataract in Kanski.  He was chuffed and said that if I ever wanted him to come back so I could take a picture, he would!  (I really need to finish that slit lamp camera)

4) 54 year old man came in for his first ever eye test.  He was struggling with fine print (if you are wondering, he was very tall and had very long arms).  Anyway, I look in one of his eyes and I see a little shard of black, slightly sparkly plastic just sitting in his stroma.  No scars.  It was in the periphery.  On the eyelid immediately above, there was a very faded, thin scar.

“Have you ever had an accident where something has went into your eye?”

“Oh, aye, 30 years ago, I was a plumber and a bit of pipe shattered. It really badly cut my eyelid but I don’t think anything went into my eye.”

“And did you go to the hospital?”

“Nah.”

So I told him that he had this little piece of plastic just sitting in the middle layer of his cornea.  It had been there for 30 years and it obviously wasn’t causing any problems.

5) 13 year old with resolving papilloedema.  His mum kept contradicting herself when I asked about attending HES. She told me that we would have to refer him back to them because they’d missed an appointment but then told me she was seeing the doctor at HES next month (for this same issue).

The boy had come in sniffing and coughing and just sat, looking like death warmed up for the whole eye test, occasionally rubbing his eyes and his nose.  On slit lamp, I discovered he had viral conjunctivitis (you should’ve seen the follicles) as well as this really bad cold (WHO BRINGS THEIR OBVIOUSLY SICK CHILD FOR AN EYE TEST?!).  I was trying to tell his mum about the contagious nature of the conjunctivitis but she just kept talking over me.  It was very frustrating.

I must’ve washed my hands, face and equipment about ten times after he left.

6) 50 year old man with previous massive trauma to his head.  Right eye lens was dislocated, traumatic cataract, atrophied iris (you could see through it temporally, on retroillumination) and massive retinal detachment.  Not that I could see the retina.  It had happened 15 years previously.

I’ve also seen a lot of AMD, both wet (resolved, not acute – not yet, anyway) and dry.  It’s been a bit of a change, dealing with low vision patients.  It’s always heartbreaking when you have to tell someone that there’s no change in their Rx, what they are currently seeing is the best their vision will get.  I have been advising on lighting and magnifiers, about moving closer to the TV if they are struggling and getting all the help they need around the house.

I’ve bought a book aimed at people with low vision that is supposed to give hints and tips about coping and making the most of their residual sight so I’ll read it and if there’s anything that I think would be helpful to know, I’ll write about it on this blog.

Advertisements