What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Saturday, May 19, 2007

Corneal Abrasions and the Herpes Virus

Being a gardener has a variety of health hazards. About a year ago, while transplanting a dracaena, I scratched my cornea. Over the course of six hours it appeared to slowly have been improving, with less tearing and discomfort. Then, for whatever reason, it began to get worse. At 9:30 P.M. I decided that my eye should get some expert attention and accordingly attended a walk-in government medical clinic. The eye was “stained” and appropriately examined, and indeed, a scratch was demonstrated. I was given an antibiotic to instill in the eye, and a “patch” was prescribed for comfort. I was assured that these corneal scratches invariably heal quickly, often within twenty four hours. This certainly fit in with my teaching and experience, but did not explain why it had suddenly gotten worse after five to six hours.
The next morning (now twenty hours) my eye was no better. Since it was not following the usual pattern of healing, I phoned an ophthalmologist that I knew. After hearing my story he advised that I be seen by him immediately. On attending his busy office I was seen shortly, examined, and advised that the corneal lesion was not healing because it had been secondarily infected by a herpes virus. He explained that people who are inclined to have cold sores may secrete the active virus in their tears, and on occasion, will contaminate a corneal scratch with the virus and proceed on to an infected scratch. This infected scratch does not have the typical appearance of a corneal primary herpes infection (punctuate lesions with fluoracein staining), but rather presents by history, as mine did, and on examination, demonstrates an enlarging lesion with inflamed “loose” epithelial edges. Accordingly, this ophthalmologist froze my eye, scraped away the inflamed loosened edges, and gave me antiviral drops for my eye to be used every two hours, and a prescription for Valtrex to be started immediately. As is the medical axiom, he advised not to cover the eye in the presence of infection, and gave me anti-inflammatory drops to be used to assist with comfort (We were taught that covering the eye was done for reasons of comfort, but should never be covered in the presence of infection). Incredibly, my eye felt much improved by that evening, and the next morning felt normal.
Fast forward to May17/07, when someone near and dear to me, telephones, and relates that she had scratched her eye that morning (she thought, but wasn’t sure how she did it. She acknowledged and recalled rubbing her eye on awakening, but wasn’t certain if it felt abnormal before or after rubbing it). In any case it was becoming more painful as the day went on, so she attended a physician, who appropriately stained her eye, saw a corneal lesion, gave her fucidin antibiotic ointment (for infection, she said) and suggested she wear a patch to cover her eye. I remarked that it was unusual to cover an eye in the presents of infection, and it may be preferable, assuming the presents of infection as related by the patient, comfort permitting, to simply try to not blink by avoiding use of the eye (eg dark room, no T.V., reading, etc) and it should steadily improve. The lesson learned at this point should be: Unless you are prepared to take over complete care and responsibility of/for a situation, as a physician, one should not give even a modicum of advice.
At 9:30 P.M. that same evening things suddenly got much worse. The patient relates much more pain and swelling about the eye, and wishes to know if she should go to the emergency department. Knowing of the long line ups for our emergency departments and the unlikeliness of her being seen by an ophthalmologist, and, having already given advice on the matter (and feeling apprehensive about it since I did not do an examination), I thought I should actually do an assessment myself. Armed with Clavulin, Amoxil, Valrex, Viroptic, and ophthalmic Voltaren drops, I make the dreaded “house call”. To my surprise there is little actual swelling of the lids or orbital area, and the redness of the eye is definitely not in keeping with a bacterial infection. (Put away my samples of Amoxil and Clavulin for possible periorbital cellulites and the like!). On ordinary examination with a bright light it was evident that the cornea itself appeared clear, but it was also evident that there was “loose” appearing corneal epithelium in the infra-pupillary area were the corneal abrasion had been identified by staining earlier that day. I left the Viroptic eye drops and Valtrex (1000mgs to be taken stat and repeated in eight hours), with instructions to use the voltaren eye drops for comfort, not to patch because of the possibility of secondary herpetic infection, and see an ophthalmologist the next day (in case the lesion needed scraping and debridement).
Some twelve hours later I receive a call saying it was like a miracle, the eye felt much improved, but the physician she had seen originally wished to recheck her eye (kudos to him for being responsible and diligent). Then these events unfold:
The original physician stains her eye and is alarmed that the stained area is much larger. He refers her to an ophthalmologist (again kudos for referring when events are not clearly understood), who tells her she does not have a herpes infection of her eye and that she enlarged her original abrasion by blinking and not wearing the patch (although we were taught that the patch was for comfort only and you did not take off normal corneal epithelium with blinking.). She was told to stop the Valtex. Now the patient is in a quandary.
From the patients’ perspective, she is likely to be fine. If she had a secondary herpes infection, the two doses of 1000mgs of Valtrex twice in the first eight hours would likely take care of it since the trend is to treat herpes early, and very aggressively, for one to two days only (although I am puzzled by the ophthalmologist not continuing the Valtrex for another day or two since it has an extremely low side effect profile). From my perspective, the patient likely denuded some corneal epithelium in the morning (this is not uncommon if the patient has had a previous finger nail scratch to the cornea, and of interest is that this patient has had corneal laser corrective surgery. Do these patients experience a higher incidence of A.M. corneal epithelial lesions?) Whether she later denuded the epithelium by blinking (are post laser corrective surgery patients that susceptible and the epithelium that fragile months later, and why isn’t this emphasized more in the literature?), or whether she developed a herpetic secondary infection to explain the enlarged lesion cannot be proven, but wouldn’t it be wise to treat a potentially damaging condition preferentially? And what is to be done in the event of future morning lesions? It is clear to me that what a patient hears from a doctor is not always clear and meaningful to the patient. People who have episodes of A.M denudation (apparently there is some drying and subsequent sticking of the corneal epithelium to the lid during sleep, and on opening the eye in the morning some epithelium is torn off the cornea) need some approach to the problem. I used to suggest some Lacrilube in the eyes at night to prevent sticking and drying in these susceptible individuals. I wonder what advice this lady was given to help her deal with the possible recurrence of this event in the future. In any case, lesson learned. I certainly will have to do a better job of monitoring my involvement in the future. A patients’ perception of a situation is not always as the attending doctor related. In this case the initial attending physician may have said the fucidin ointment was to PREVENT an infection; not FOR an infection, and in that case, the patch was quite appropriate.

17 Comments:

Blogger Unknown said...

Hi, I read your story very carefully and it really helped me. Thank you. I've had the symtom(especially in the morning) for an half year,been couple of eye doctors but they only gave me antibiotic and ointment. I think now I better print this and bring it to doctors;;anyway will this be perfectly cured?

3/7/08 7:37 PM  
Blogger Unknown said...

Hello I have severe problems with My health I have herpes I must take valtrex frequently and I have ED problems and I must take Generic Viagra every night

25/9/09 3:11 PM  
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26/8/10 9:23 PM  
Anonymous viagra online said...

Now the patient is in a quandary.
From the patients’ perspective, she is likely to be fine. If she had a secondary herpes infection, the two doses of 1000mgs of Valtrex twice in the first eight hours would likely take care of it since the trend is to treat herpes early, and very aggressively, for one to two days only (although I am puzzled by the ophthalmologist not continuing the Valtrex for another day or two since it has an extremely low side effect profile).

14/4/11 2:07 PM  
Blogger Sweetie said...

Indeed a good read & helped me understand the issue I'm currently facing.. Thank you very much for the write up.

27/6/11 1:19 PM  
Anonymous scratched my eye said...

Great post! I just scratched my cornea, it's terrible.

19/10/14 9:48 PM  
Blogger Unknown said...

Honey is capable of healing the abrasion as well as protecting it from infection. It has all the antiseptic and antibacterial properties that make it the best choice to deal with abrasions. It also reduces the possibility of scarring in case of deep abrasions. Only one thing you have to be careful about is the use of quality honey only.You can also read some Best Home Remedies for Skin Abrasions.

9/4/16 4:02 AM  
Blogger Unknown said...

There are lot of products available in the market but which one is choose, a big problem. Don't care. We provide you the best Home Remedies For Abrasions which has all antiseptic and antibacterial properties that make it the best choice to deal with Abrasions.

13/5/16 1:04 AM  
Blogger Unknown said...

Whenever we think about our eyes, even a little problem in eyes can steal our sleep. Corneal herpes is the infection that affects your eyes. This type of herpes virus can cause inflammation, redness and itching in the eyes. If you have this problem, you should try corneal herpes zoster treatment . Early treatment can protect your eyes from the damage done by this infection.

17/3/17 3:08 AM  
Blogger lucawalstab said...

Good article. As we all know eyes are the most sensitive parts of our body which need extra care but corneal infection can lead to inflammation and burning in your eyes. This problem can also lead to lifetime blindness so, herpes simplex treatment is the only option to protect your eyes from this annoying infection. This treatment will reduce your symptoms and give relief from the pain in eyes.

17/3/17 4:20 AM  
Anonymous linda Donna said...

Natural cures for herpes have been in existence before the first Olympian threw a disc or ran a race. Modern Medicine came in like a conquering hero and all the old remedies were soon forgotten and swept under the rug. It wasn't until someone investigated all the possibilities and combinations of ancient remedies that many of the natural cures became popular.I Linda Donna, I was herpes patient for two year and have taken different prescription of drugs or medicine but there was no cure i became very sick and frustrated also, Until my friend saw and read a testimony of a lady on this blog on who was cured of HIV~aids by Dr Akhigbe. With his herbal remedies cure, We contacted him through his email, drrealakhigbe@gmail.com He reply us and told us what to do, He prepared the herbal medicine and send it to me through Dhl courier services, and instructed me how i will be taking it. My grated surprise is getting to three weeks my herpes get cure totally. Brother and sister Dr Akhigbe herbal remedies cure is very powerful. I have to testify him here so that everyone can get the information here.Dr Akhigbe also cure diseases like,. DIABETES,ALS,HIV~AIDS,CANCER, FIBROID,HERPES ,HEPATITIS..In case you are there and you need his help please contact his email, drrealakhigbe@gmail.com or WhatApp HIM ON +2348142454860

22/3/19 2:38 PM  
Anonymous TINA PHILIPA said...

There is another great option for herpes home remedy. It is simply because so many of us don't know the right one to meet at the right time . I was deadly in pain of herpes for six months, I tried different cure but it could not heal, one day my friend Jane saw a testimony of a lady'Edith' on this blog. how her herpes was cure by Dr Akhigbe with his herbal medicine cure that can help to heal the blister and sores of herpes totally.We write to him through his email, drrealakhigbe@gmail.com he told us that he was going to help us. He prepared the medicine and sent it to us through UPS courier services , he also instructed me on how i will be drinking the herbal merdicine for three weeks. My dear brothers and sisters, Dr Akhigbe herbal medicine cure is real and it cure my herpes totally. So i must testify of him, he is a good man and i call him daddy.. If there any one out there that need his help because Dr Akhigbe cure different diseases.. Please contact him on his email... drrealakhigbe@gmail.com or you can also whatApp him with these number +2348142454860 Dr Akhigbe is good herbalist man to be trust

25/3/19 3:31 AM  
Anonymous TINA PHILIPA said...

There is another great option for herpes home remedy. It is simply because so many of us don't know the right one to meet at the right time . I was deadly in pain of herpes for six months, I tried different cure but it could not heal, one day my friend Jane saw a testimony of a lady'Edith' on this blog. how her herpes was cure by Dr Akhigbe with his herbal medicine cure that can help to heal the blister and sores of herpes totally.We write to him through his email, drrealakhigbe@gmail.com he told us that he was going to help us. He prepared the medicine and sent it to us through UPS courier services , he also instructed me on how i will be drinking the herbal merdicine for three weeks. My dear brothers and sisters, Dr Akhigbe herbal medicine cure is real and it cure my herpes totally. So i must testify of him, he is a good man and i call him daddy.. If there any one out there that need his help because Dr Akhigbe cure different diseases.. Please contact him on his email... drrealakhigbe@gmail.com or you can also whatApp him with these number +2348142454860 Dr Akhigbe is good herbalist man to be trust..

25/3/19 4:00 AM  
Anonymous Lilian Wale said...

There are some natural remedies that can be used in the prevention and eliminate diabetes totally. However, the single most important aspect of a diabetes control plan is adopting a wholesome life style Inner Peace, Nutritious and Healthy Diet, and Regular Physical Exercise. A state of inner peace and self-contentment is essential to enjoying a good physical health and over all well-being. The inner peace and self contentment is a just a state of mind.People with diabetes diseases often use complementary and alternative medicine. I diagnosed diabetes in 2010. Was at work feeling unusually tired and sleepy. I borrowed a cyclometer from a co-worker and tested at 760. Went immediately to my doctor and he gave me prescription like: Insulin ,Sulfonamides,Thiazolidinediones but Could not get the cure rather to reduce the pain but brink back the pain again. i found a woman testimony name Comfort online how Dr Akhigbe cure her HIV  and I also contacted the doctor and after I took his medication as instructed, I am now completely free from diabetes by doctor Akhigbe herbal medicine.So diabetes patients reading this testimony to contact his email     drrealakhigbe@gmail.com   or his Number   +2348142454860   He also use his herbal herbs to diseases like:SPIDER BITE, SCHIZOPHRENIA, LUPUS,EXTERNAL INFECTION, COMMON COLD, JOINT PAIN, EPILEPSY,STROKE,TUBERCULOSIS ,STOMACH DISEASE. ECZEMA, PROGENITOR, EATING DISORDER, LOWER RESPIRATORY INFECTION,  DIABETICS,HERPES,HIV/AIDS, ;ALS,  CANCER , MENINGITIS,HEPATITIS A AND B,ASTHMA, HEART DISEASE, CHRONIC DISEASE. NAUSEA VOMITING OR DIARRHEA,KIDNEY DISEASE. HEARING  LOSSDr Akhigbe is a good man and he heal any body that come to him. here is email    drrealakhigbe@gmail.com    and his Number +2349010754824

29/5/20 9:35 AM  

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