And so it starts...

I was up at 6, partly because I actually got enough sleep over the weekend (yay naps) and partly because of first day of school jitters. I was showered and out of the house fed and coffee'd and everything by 7:15, and made it to school by 7:30 by bike.

I did my locker stuff, checked my mail and hung out and finished my coffee until about 7:50, then headed over to Ophtho for orientation. The other three people on my rotation showed up right at 8am, I felt weird standing around being early for 10 minutes. I'm NEVER the early one!

Orientation was actually fun. Dr P is really an amazing teacher, particularly when it was just her and 4 of us. We went over all of the intake and exam stuff, and actually got to do it all on a volunteer dog (J, one of the ophtho tech's dog). J hung out all day, which was neat except for the bits where he was dog aggressive to some of our patients... oops. After 2 hours of going through stuff, which I swear flew by, I kinda felt like maybe I had a grasp on what I was supposed to be doing and in what order. Then appointments started!

I sat in on part of a "blind dog" exam that was P's case. The dog has a number of neurological changes in the last month, including loss of vision. We did an electroretinograph (ERG) at lunchtime, and the retina was mostly processing light normally. That confirmed the neurologist's diagnosis of a brain tumor inducing cortical blindness, which kinda sucked.

I went in with J on a dog who was a recheck for a lens luxation. The lens was hanging out in the back of the eye, and the dog has been on drops for years that cause the irises to seriously be pinpricks. I've heard the memory tool of: parasympathomimetics produce pinpoint pupils - but I'd never actually had the opportunity to see just how SMALL it makes them. I'd say the pupil was less than a millimeter in diameter, when a normal dog - even in very bright light - can usually only get down to 3 or 4mm. The other lens on the dog was "loose" and was also be kept in check with the drops. The theory is that a lens that's not where it's supposed to be but in the posterior chamber of the eye does a lot less damage and causes a lot fewer side effects than a lens hanging out in the anterior chamber (against the cornea). The dog passed the recheck with flying colors.

My first "primary" case of the day was a dog who had "possible glaucoma" from the referring vet (rDVM). The little shih tzu was adorable, but her eyes were AWFUL. In her left eye she had blood vessels growing across the cornea and increased corneal thickness from chronic inflammation and irritation probably from dry eye (keratoconjunctavitis sicca, KCS). The dog also had both nuclear sclerosis and a small cataract in the eye. She had about 25% vision in the left eye, and was mostly likely only seeing shapes and shadows. Her right eye was worse.

The right eye was completely blind, had both neovascularization (the corneal blood vessels), pigmentation from chronic irritation, clinical dry eye (KCS) diagnosed by a tear production test, and a small ulcer. The parts of the cornea that we could see through showed that the eye itself was filled with blood, called hyphema. The intraocular pressure of the eye was also between 24 and 34, diagnostic for glaucoma (increased pressure inside the eye). We (okay, Dr K) suspected a mass inside the eye, retinal detachment from high blood pressure, or a clotting disorder. The owners declined an ultrasound (to look for a mass or a blood clot or retinal detachment) and bloodwork, and opted to only treat the ulcer and the glaucoma. The treatment for the dry eye is another set of drops given 2-3 times daily, and they were having trouble considering that many eyedrops per day. the treatment for the blood in the eye is steroids, and we can't give steroids into the eye while there's an ulcer present.

In the end, we still ended up sending the dog home on three separate eye drops, which have to be given 5 minutes apart 3 times a day, and kept the dog on oral steroids that the rDVM had prescribed. It was a very hard case to write up, just because there were so many findings that may or may not be related, dependent on the workup we were not allowed to do, and then the instructions for the medications were challenging as well.

And that was just before lunch!

After lunch I, um, oh crap. I forget already. I know that I did an emergency that came in with a fixed, dilated pupil. It was this cute little 5ish year old miniature poodle who weighed all of 5 pounds. She could see fine, wasn't painful, squinted a little - but mostly had been into the vet this morning and the rDVM had noticed the eye abnormality and referred her in. I did everything right, got good readings, and the dog ended up being diagnosed with profound iris atrophy. That essentially means that for some animals the iris just... goes away. It doesn't affect the dog's vision, but they can become sensitive to very bright lights... predictably. We noticed that the other eye had the beginnings of atrophy as well, and advised the owner to check out www.doggles.com - but that was about as far as we had to go. It was a great learning experience as well as a fun time.

I appear to have lost a couple of hours in the afternoon - I wonder what I was doing during that time... But that was just the first day!

Tomorrow, entropion surgery and teaching sophomores eye exams!