Clinics

As usual, interesting clinic patients from the week:



Microphthalmos, right eye. This 15 year old girl knew that the right eye would never see well, but all she wanted was to look "normal". The poor thing started crying and asked if there was anything we could do for her.



Microphthalmos

Microphthalmos, right eye

*****

Band keratopathy in central visual axis, right eye

Band keratopathy in central visual axis, left eye. He had hand motions vision in both eyes and a significant cataract as well. He will undergo bilateral EDTA chelation therapy tomorrow, and then subsequent cataract surgery.

*****

 

Patient with nearly 360 degrees of posterior synechiae (previous uveitis, now quiet). This photo is after we attempted to dilate her eye.

***** 

My favorite part of the above clinic note (written by a visiting doctor): "6th CN palsy has resolved. (Never had CT scan due to broken scanner.)" Yes, the country's one CT scanner was apparently broken!

 *****

30 year old gentleman with previous corneal ulcer on this eye, that left him with peripheral corneal thinning. He went away for several months to South Africa and missed his follow-up appointments. Unfortunately, he came back to us with count fingers vision in this eye (previously 6/6, or 20/20). This is how he presented to me yesterday. Yep, he perforated. We are treating him with aggressive antibiotics and hoping the area will scar down. Eventually we could do a pupiloplasty to enlarge the pupil to clear his visual axis.

 *****

 

Yet again, vernal keratoconjunctivitis (VKC) I show this photo because the vision was about 20/200 in this eye secondary to obscuration of the visual axis. This poor child's other eye was about 20/60, but she was having difficulty in school secondary to her poor vision (see note below from the grandparents who are her guardians). I think it is easy to forget that things such as severe VKC can potentially be blinding eye conditions.

 Note from grandparents alongside her many clinic notes. In Africa, it is not uncommon for children to be raised by their grandparents. HIV was the cause of the mother's death, as it is in many cases of orphaned children here in Swaziland.

***** 

My most amusing patient of the week. She has gone to a fair at the Mavuso Trade Center in Manzini because her eyes were red. She saw the eye doctor's booth there, and without examining her, he told her she needed an operation or she would be blind within the next month. (I will not say where or what country this doctor is from, but Jono has heard a lot about this person, and Jono sees all of this doctor's complications). At any rate, she was a staunch Catholic and so she went to Gome (in South Africa) and purchased some "Mother Mary's Water", which she had been putting in both eyes. Her son suggested that prior to a major eye operation (I honestly don't know what operation was even suggested), she see Dr. Pons. I did a full eye exam. Her vision was 6/9 in both eyes uncorrected (20/30). She had normal appearing discs, normal intraocular pressures, no diabetic changes in her fundus... I reassured her, told her we should do a dilated diabetic exam in one year's time, and told her to be happy. She was so excited and proclaimed that it was a "miracle"! Yes, folks, my normal eye exam made her "miracle" come true. She was just a wonderful, lovely, great patient, who made my day! (She then started telling the next patient in the queue that all she needed to do was put Mother Mary's Water in her eyes and be a "believer".) I let them discuss :)

***** 



I am finally official! I was a "legal" doctor in Swaziland as of October 20th :) I received it just in time for my departure back to America.

 

 I have more interesting clinic patients, but I think I will post tomorrow. The internet is quite bad tonight, and it has taken me WAY too long to update the blog tonight. I'm not complaining...just frustrated!!