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.