Update

Today was a great day in the OR. Cataracts, a permanent lateral tarsorrhaphy, removal of band keratopathy with ETDA chelation, and excision of an apocrine hidrocystoma.

Tomorrow Angela (the clinic administrator from South Africa) and I are off to South Africa to go the Drakensberg! I am excited for a day off, as it has been awhile! We are going to make our way to the Drakensberg tomorrow, spend a day there, and then go on to Durban (where she has a house) and stay there for a night. We are excited for our girls' weekend, and my "last hurrah", as it is my final weekend here!

Ang has been a great friend, always willing to lend an open ear, offer sage advice, and keep me laughing. I am going to miss her dearly, and I am glad we get to spend this final weekend together.

It was fun keeping this blog while in Swaziland, and it'll be sad to put it on hold for five months, until I go to China in the spring. If nothing else, it has provided me a way to remember this wonderful country and this wonderful experience.

And now, here are a few more clinic photos from the week.

 

A lady in her 80s with a large mass growing on the left side of her face for the past two months, per her report. She had a normal eye exam other than the superior displacement of the globe. She had relatively full ocular motility and no RAPD. We sent her to ENT for workup and imaging. I presume it is some sort of maxillary sinus mass. Other than hypertension, she has no other known medical problems.

*****

The gentleman below presented with a left pupil-involving third nerve palsy. He states his lid started drooping several months ago. He is HIV positive and had a squamous cell carcinoma excised from the left eye recently.

He also has signs of aberrant regeneration, which is a sign of chronicity (several months, at least). The aberrant regeneration is evidenced by the lack of complete ptosis on the left and the left eyelid "flying up" on attempted adduction of the left eye (third photo). I sent him to the government hospital for imaging of the brain and orbits to rule out a compressive lesion. He also needs vascular imaging, but I am not sure that is an option here in Swaziland.  



Photo 1: Primary gaze.



Photo 2: Upgaze.



Photo 3: Right gaze. Note the left eyelid has retracted on attempted adduction of the left eye. This is not normal, and indicates aberrant regeneration, which is a sign of chronicity (of the CN III palsy).



Photo 4: Left gaze.



Photo 4: Downgaze.



Photo 5: Right pupil (reactive).
 

Photo 6: Left pupil ("blown" and non-reactive).

 

And a quick humorous story: today I went to the eye clinic and got dressed for the OR. The scrub top was inside out, but as there is no "right" or "wrong" side in the US, I put it on what would technically be considered "inside out" and carried on. As soon as I got in the OR, one of the new scrub techs said, "Why is your shirt on inside out? You know in our culture that means that your husband or significant other died and you are in mourning." I thought he was joking, but he wasn't. I guess it is also a way for the bereaved woman to signal that she is now single and looking for another man... Hahaha. I promptly went in to the ladies room and turned it right-side-out!

 

Oops. I guess I wasn't aware of what inside-out clothing means in Swaziland.

 

The driveway into work. There is a snack shop and a hair salon :)

Snack shop on the left, hair salon on the right.

 

A tiny Green Bay fan in Swaziland (or more likely, a donated shirt)!  This is for all my friends from Wisconsin and my family/friends that are huge Packer fans.