episode_0160

Episode 160. I can’t see (2)

****

The patient was looking at me with a suspicious look. What should I do when he needs urine for diagnosis? Should I just hide it?

I looked at the patient.

“No, why is this necessary?”

“Yes.”

“If your blood sugar is high, your blood can become sticky and block your blood vessels. That can affect your kidneys and cause abnormal urine output. The blood vessels in your eyes are delicate and can be damaged.”

“Um… ….”

“The disease I suspect is the cause of the patient’s partial blindness is diabetes. That could be the cause of the blurred vision.”

“Diabetes? Isn’t that a disease that only fat old nobles get? Why would I.”

“There can be many causes.”

This patient was relatively young and did not seem to be of an age to develop diabetes, but diabetes is not necessarily caused by lifestyle habits.

The most common is diabetes as an adult disease, but there are many reasons why you can develop diabetes, such as genetic diseases or pancreatitis.

We brought a large bottle of water next to the patient, and the patient started drinking the water.

****

Istina tilted her head.

“Can you really tell a patient’s condition by drinking urine? I thought it was a superstition.”

“Some people do that.”

“Isn’t that unscientific?”

I shook my head slightly. There’s nothing unscientific about tasting urine to see if it contains protein or sugar. It’s just unsanitary.

A few minutes passed like that.

I stood next to the patient and thought for a moment. The patient was not at an age where cataracts or glaucoma would develop, and there were no signs of such in his eyes. It seemed to be a problem with the retina or nerves rather than the lens or vitreous body.

Judging from the fact that he had no intention of urinating, he did not seem to have diabetes. If the kidneys are damaged by diabetes, it is normal for excessive urination to accompany it.

Judging by the pupillary reflex, it didn’t seem to be a problem with the central nervous system. Fortunately, it wasn’t diabetes or the brain.

The patient had to urinate anyway.

Even when I sniffed the urine, it didn’t smell particularly sweet or anything. I’d have to eat it to be sure. Well…

I didn’t want to save this patient that much. I just wanted to live with one eye closed.

I’m half joking. If we look at the evidence, it’s unlikely that this patient’s illness was diabetes.

In the case of diabetic retinopathy, the available treatments are limited. Usually, it is treated with lasers, right? That is not possible here.

If not diabetes, what other diseases are possible?

Even if you can’t cure the patient, you should at least find out why they’re sick.

“Patient. Would you like to try this?”

“What else?”

“Press your eyeball firmly with your finger until you feel your eye is pressed properly.”

“Then what happens?”

Let’s assume that it is an acute retinal artery occlusion due to a blood clot. If the eye is massaged well to change the intraocular pressure, the blood clot blocking the retinal artery may move and make it visible again.

“You may see it again.”

“I see. My eyes are already a little wet.”

“You should feel like you are pressing on your eyeballs, not rubbing your eyelids.”

The patient did as I told him for now.

“What’s different?”

“Hey!”

The patient squinted his left eye.

Has it really changed?

“Still, it seems a little better than before. The light and dark are starting to be distinguished.”

“Okay.”

To summarize the information given so far.

Judging from the amount of urine, it is not diabetes, the reflexes show no central nervous system disease, and looking inside the eye, it is not a problem with the lens or vitreous body, such as a cataract.

That’s all that’s left.

Retinal artery occlusion due to arterial thrombosis. A small blood clot is blocking an artery in the back of the eye, in the retina. Treatment needs to be considered.

****

Then. What is the treatment for retinal artery occlusion? Since ophthalmic surgery requires such sophisticated equipment, it is not worth considering.

There were quite a few things to try.

First, anticoagulants may be prescribed, but there is no guarantee that anticoagulants will be able to eliminate clots that have already formed.

rtPA.

There is a drug called recombinant tissue plasminogen activator that can dissolve clots in stroke patients, but it is unlikely to be effective in this patient.

It has to be written within 3 hours, but in this patient’s case, almost a day has passed.

I don’t know if it’s a situation that can be compared to a stroke. It didn’t seem like a good direction.

Next thing to try is… … .

Needle. You can lower the pressure in your eye by inserting a needle into your eyeball. This will lower the pressure in your arteries, causing them to dilate and possibly allowing the clot to pass. It’s a bit of a risky method.

I sighed.

As for the urine problem earlier, I think I’m just making unreasonable demands on this patient. I wonder how he’ll react if I tell him that I have to poke his eye with a needle. Of course he’ll freak out, right?

“Patient. I found what the problem was.”

“What is it?”

“It seems like this happened because the blood vessels in the back of the eye, the retina, are blocked and blood flow is blocked there. Treatment is available.”

“Oh, thank goodness. What’s the cure?”

“Putting a needle in your eye.”

“Is that… … possible?”

A surprising fact.

possible.

Newton stuck a needle in his eye several times and recorded the results. This was part of his experiments on the properties of light and color.

I’ve said this several times. Newton wasn’t in his right mind. His brain may have been damaged by exposure to various toxic substances due to alchemy, or he may have just been a strange person to begin with.

Anyway, Newton isn’t important right now.

They’ll remove a small amount of fluid from the eye with a needle, lower the pressure in the eye, and see if the clot moves. If that doesn’t work, they’ll use an anticoagulant.

“By removing some of the fluid inside the eye, we will lower the pressure in the eye. This will dilate the artery, allowing the clot to move back.”

“Oh, do I have to do that?”

“Well, I think this is the best way. You could use medicine, but that’s not a sure thing either.”

“What if my eyes move while I’m inserting the needle?”

“There is anesthesia.”

“It doesn’t hurt, right?”

I nodded.

As scary as it sounds to have a needle stuck in your eye, it really doesn’t hurt.

It’s just a needle being inserted after anesthesia, and it’s not much different from other areas. There is one thing that says you should never rub your eyes.

Not trivial.

“It won’t hurt.”

“Okay… … .”

“Then. Let’s begin.”

The patient sighed deeply and nodded helplessly. I took the anesthetic out of my pocket. It won’t take long, and the effects will be immediate.

It wasn’t a look of trust.

“Stay still.”

I put anesthetic eye drops on the patient’s eyes. The patient blinked repeatedly. It must have been a strange feeling when the anesthetic was applied.

This is because the orifices in the face are interconnected. When anesthetic is injected into the eyes as eye drops, it often flows into the nose.

It’s not a problem if the anesthetic flows into your nose, but it can be uncomfortable.

“Istina. Come and fix the patient’s head.”

Be sure to only stab the white part of the egg.

You must not move at all, because if you poke the pupil or iris, you could go blind. We laid the patient down on the examination room bed.

Three hands held the patient’s head in place.

“Patient, please hold your head with your hands.”

“Oh, yes.”

Five hands held the patient’s head in place.

I lifted the needle carefully.

“You must never move.”

The needle approached the patient’s eyeball. The anesthesia seemed to be working properly. There was no pupillary reflex or movement at all.

“But, have you tried this?”

“Don’t say anything.”

Actually, I haven’t done it much.

Even if it’s an emergency room, patients with eye problems don’t even go near it and they call an ophthalmologist right away. They can at least do a wash.

I put my elbow on the bed and inserted the needle into the patient’s eyeball while keeping movement to a minimum. A small amount of clear liquid came out.

The needle was pulled out again.

“It’s all over. I’ll be hospitalized for a day to see how things are going. Is there any change in what you see? Are you feeling better?”

“I think it’s a little visible.”

“Can you see it or not?”

I took one eye patch from the locker in the sickroom and gave it to the patient. The patient quietly put the patch on the eye that had just had the needle inserted.

“Wear an eye patch for a few days to avoid straining your eyes. If possible, do not remove it.”

“Yes.”

“It didn’t hurt much, did it?”

“It hurts.”

I thought about it for a moment. Well, it’s impossible for a needle to not hurt when it’s stuck in your eye. For now, I thought it wouldn’t be a big deal.

“Then. If anything changes, please let me know. And don’t rub your eyes.”

The patient nodded.

****

I’m glad that her eyesight has recovered a little. I don’t know if it will fully recover, though. I took Istina out of the hospital room.

Istina tilted her head.

“So, you don’t know what caused this patient’s acute partial blindness? You just put a needle in the eye to relieve the symptoms?”

“Right.”

“What disease do I need to find out?”

Nothing immediately occurred to me. Why would a seemingly healthy young man have arterial clots?

To be honest.

Lucky for this patient.

Retinal artery occlusion is a tragedy, but if the clot had traveled to the brain and lodged, it could have caused a stroke. The prognosis could have been much worse.