Eyeballing it

"who would believe that so small a space could contain all the images of the whole universe?"

- Leonardo da Vinci

I just finished my rotation on ophthalmology and that was my resident's favorite quote. Ophthalmology was a nice change of pace from general surgery! Days were usually about 8am-4pm instead of the 5am-5pm that I had become accustomed to. One day general surgery clinic finished up around 3:30. The intern said “well there’s nothing for you to do, but it’s too early to let you go home.” He had me sit around for another 30 minutes before deciding it was okay to release me. My first day on ophthalmology the resident asked what I was still doing there at 4:00. I had a lecture at 4:30 I explained.

Procedures on ophthalmology go pretty quickly, so I was able to see a lot of them. A large majority were cataract surgeries. Apparently everyone is destined to get cataracts if they live long enough. I also spent 2 days in the refractive surgery center seeing LASIK and PRK. There wasn't much for me to do in those procedures, but I was able to participate in the minor procedures, snipping a bump off an eyelid! I have to admit I was a little squeamish about seeing eyeballs get poked at first! I don't know why, but I'm fine with blood and guts, but seeing a needle go into an eye just made me cringe. After about a week I started to get used to it and it didn't bother me as much.

Most of the clinics or procedures I was scheduled to be at only lasted a half day, so the default place for me after that was the acute clinic. A surprising majority of those visits were attributed to blepharitis - basically clogged oil glands along the eyelid. Patients would come in with redness, dryness, pain and/or blurred vision and they all seemed to have those clogged glands when we looked up close. Fortunately the treatment is extremely simple - warm compresses to melt the oil in those glands.

I did see two retinal detachments in the acute clinic, which were interesting. The first one, unfortunately was too late and no longer an emergency. The patient had noticed a shadow coming across his vision for about a week. His retina had already detached across his central vision. They would still do surgery to try and "put the wallpaper back up" but his vision would never be the same. The second patient came in a day or 2 after he noticed this same shadow encroaching on his vision. In his case he still had his central vision and would be scheduled for surgery right away to try and save his remaining vision. Both of these patients had warning signs earlier that they had ignored - new floaters and flashes of light. So PSA to everyone - new floaters, flashes of light or curtain coming across your vision is an emergency! See an ophthalmologist or you could go blind. The floaters come from vitreous (jelly inside the eyeball) detaching - which in itself is not a problem, but can be a warning sign. The flashes of light are the vitreous actually tugging on the retina. The retina is a direct connection to the brain and the flashes are electrical signals. And the curtain is actually the retina coming down - bad news!!

I initially didn't think I would be that interested in ophthalmology, but I can see why people choose it. They have a pretty good lifestyle and still have the opportunity to perform procedures on a regular basis. Eyesight is something that people really care about, so it's important work. All the doctors that I spoke with loved seeing patients so happy to be able to see after operations like cataract surgery or refractive surgery.

At the end of this week I had an abrupt transition to cardiothoracic surgery with a 13.5 hour first day including a quadruple bypass and tending to patients in the ICU. More on that rotation later!