First full day at Lumbini: Cornea clinic


I spent my first full day at LEI in cornea clinic today, seeing patients with Dr. Dhakhwa (trained with Geoff Tabin at Moran).  There is one room for each subspecialty clinic with two slitlamps – one for the ophthalmic assistant or technician to start the patient and the other for the doctor.  Patients wait in the hall until they are called in to be worked up.  When clinic began, Dr. Dhakhwa invited me to sit next to her at her slit lamp so that we could examine patients together.  “How many perforated corneal ulcers have you seen during all of your residency?” she asked.  I told her five or six, I thought.  “We’ll see that many before lunch,” she responded.  She was not far off.

Most of the corneal ulcers seen at LEI are fungal, related to agricultural injuries.  Management is a little different from what I’m used to – there is no tissue glue here and graft material is very scarce.  Patients are admitted to the inpatient service for high dose antimicrobials to quiet the eye, and then a few days later undergo a Gundersen flap.  Graft tissue can occasionally be obtained from Kathmandu if the patient already has poor vision in the other eye.

Over the course of clinic, I also saw trachoma, phlyctenular conjunctivitis, and bilateral HSV-keratitis – all new to me.

3 comments to First full day at Lumbini: Cornea clinic

  • Marian Hoppes

    What a wonderful opportunity for you, sad for the patient and frustrating for physicians to not have the availability to resources that we do. One room for each sub speciality yikes! Stay safe.

  • Susan Ratzan

    Hi Cran, It sounds like you are having an incredible experience and are working with some excellent teachers! Meanwhile the Northeast is paralyzed by Blizzard Charlotte. All roads in CT are closed. All trains and airports are closed including Logan and Bradley. Our driveway has been plowed twice and we still can’t get out because the roads aren’t passable yet. Rich will document with lots of photos. Thanks for your blog and photos from Nepal. S.

  • pampeeler

    Cran—Sounds like you are right into the thick of it. My question of course is how can they get tissue glue? Probably not as easy as a UPS package.
    Maine is also buried in the giant storm. Maddie is having a rough go getting around in 3″ feet of snow—but we did not lose power, so it is all okay.
    Keep the news and photos coming. Love, Mom

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