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Medical Forum / General / Vision / June 2005

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Aversion to eyedrops?

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dumbstruck - 03 Jun 2005 09:40 GMT
What are the consequences of not using eyedrops in exams? Patient has
sensitive eyes and even if willing, goes into violent reflex action if
drops touch the eye.

What are they important for, glaucoma test and some aspect of acuity?
For glaucoma or whatever I guess a dialation drop is preferred.
Patient sat for about a dozen attempts to drop in eye (lunging to
ceiling each time), then had terrible results that suggest an overdose
had made it in.  Also seemed to pick up a bunch of "floaters"
afterwards.

Also had minor trouble with the air puff glauc test being hurtful (even
hurts to open eyes underwater).  Doc seemed to say he could tell
glaucoma by some surface measurement instead, but?  Anyway, patient now
averse to using eyedrops, but is will this miss shedding some impt
light in the acuity realm also?  Thanks for opinions or alternatives...
William Stacy - 03 Jun 2005 16:46 GMT
> What are the consequences of not using eyedrops in exams? Patient has
> sensitive eyes and even if willing, goes into violent reflex action if
> drops touch the eye.

Using no drops restricts significantly some parts of the exam; it
essentially makes it impossible to see the peripheral retina at all.

> What are they important for, glaucoma test and some aspect of acuity?

Not acuity, but for glaucoma, it is helpful.

> For glaucoma or whatever I guess a dialation drop is preferred.
> Patient sat for about a dozen attempts to drop in eye (lunging to
> ceiling each time), then had terrible results that suggest an overdose
> had made it in.  Also seemed to pick up a bunch of "floaters"
> afterwards.

Sounds like someone who should put the drops in themselves.

> Also had minor trouble with the air puff glauc test being hurtful (even
> hurts to open eyes underwater).  Doc seemed to say he could tell
> glaucoma by some surface measurement instead, but?  Anyway, patient now
> averse to using eyedrops, but is will this miss shedding some impt
> light in the acuity realm also?  Thanks for opinions or alternatives...

Air puff is not as accurate as goldmann, but often is acceptible. I
reommend using numbing drops first; makes subsequent drops far easier to
take. Again, nothing at all to do with acuity. Consider taking Valium
before next exam.

w.stacy, o.d.
Dan Abel - 04 Jun 2005 00:03 GMT
> Consider taking Valium
> before next exam.

Excellent idea.  How does one get these?

I've already posted the sad story of my last cataract surgery.  My first
went without a hitch.  I can't say that it was a lot of fun, but it wasn't
bad, and I felt fine afterwards and the next day.  I should have realized
that I was in trouble for the second one when I asked my doctor how long I
would be off work and she said I could go back to work the next day.
Right before the surgery, I told the anesthesia guy that I wanted lots of
tranquilizer, and he replied, "Uh, this doctor doesn't believe in that".
I was miserable, and totally unable to stay still, which is important when
the doctor is slicing up your eye.  I was in a state of panic, and
literally terrified.  I don't know if my inability to stay still
contributed, but I was in horrible pain that night, and totally blind the
next day until the doctor reduced my IOP from 40 down to ?.  I was off
work 3 days, mostly due to mental trauma.

I don't like visiting the dentist, either.  He did a terrible job on my
first filling, partly because (as he said) it was the very hardest
location to work on and I couldn't stay still then either.  I was also
unable to keep my tongue from wandering into his way, and couldn't keep my
mouth in the correct position.  For the second filling, I self-prescribed
a tranquilizer after the receptionist told me they don't give sedatives.
I drank two glasses of whiskey before the procedure.  I'm sure my breath
wasn't too pleasant!  But the procedure went much better.  I walked to the
office, and took the day off since I knew I wouldn't be worth anything at
work anyway, even without the anesthetic (not to mention that I have 100
sick days on the books, or over four months).

Signature

Dan Abel
Sonoma State University
AIS
dabel@sonic.net

The Real Bev - 06 Jun 2005 21:17 GMT
> <wstacy@obase.net> wrote:
>
[quoted text clipped - 9 lines]
> Right before the surgery, I told the anesthesia guy that I wanted lots of
> tranquilizer, and he replied, "Uh, this doctor doesn't believe in that".

Then let HIM go to the dentist cold turkey!  I thought the anaesthesiologist
got to choose the anaesthesia.

> I was miserable, and totally unable to stay still, which is important when
> the doctor is slicing up your eye.  I was in a state of panic, and
[quoted text clipped - 8 lines]
> unable to keep my tongue from wandering into his way, and couldn't keep my
> mouth in the correct position.  

I thought most dentists used rubber dams now, which keeps the tongue out of
the way and prevents shooting ground-up bits of tooth down your throat.

> For the second filling, I self-prescribed
> a tranquilizer after the receptionist told me they don't give sedatives.
> I drank two glasses of whiskey before the procedure.  I'm sure my breath
> wasn't too pleasant!  

Serves him right!  

> But the procedure went much better.  I walked to the
> office, and took the day off since I knew I wouldn't be worth anything at
> work anyway, even without the anesthetic (not to mention that I have 100
> sick days on the books, or over four months).

When I was canned, I had over 700 hours of sick leave that evaporated before
my very eyes.  How STUPID of me not to have taken more mental health days!

Signature

Cheers, Bev
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"They redundantly repeated themselves over and over again
incessantly without end ad infinitum" -- ibid.

Dan Abel - 07 Jun 2005 00:30 GMT
> > Right before the surgery, I told the anesthesia guy that I wanted lots of
> > tranquilizer, and he replied, "Uh, this doctor doesn't believe in that".
>
> Then let HIM go to the dentist cold turkey!  I thought the anaesthesiologist
> got to choose the anaesthesia.

She, and I'll bet she does.  And although I'm happy with my HMO, they
don't have an anesthesiologist for the patient, but a nurse anesthesist.

> > But the procedure went much better.  I walked to the
> > office, and took the day off since I knew I wouldn't be worth anything at
[quoted text clipped - 3 lines]
> When I was canned, I had over 700 hours of sick leave that evaporated before
> my very eyes.  How STUPID of me not to have taken more mental health days!

Yeah, I should work on that.  Being a state employee with 25 years in,
they would find it hard to can me.  Although we don't get paid for unused
sick leave, we can add it to our service credit, meaning that although I
have 25 years here, I would get credit for that 25 plus my unused sick
leave at the time of retirement.  Better than nothing.

Signature

Dan Abel
Sonoma State University
AIS
dabel@sonic.net

The Real Bev - 08 Jun 2005 00:01 GMT
> > > Right before the surgery, I told the anesthesia guy that I wanted lots of
> > > tranquilizer, and he replied, "Uh, this doctor doesn't believe in that".
[quoted text clipped - 18 lines]
> have 25 years here, I would get credit for that 25 plus my unused sick
> leave at the time of retirement.  Better than nothing.

Take the time off.  It's irreplaceable.

Signature

Cheers, Bev
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