C09991694 / invoice 10000

eye still irritationg her, trying to scratch after taking her off eye meds friday

HISTORY
Presenting for: Miso, a 14-year-old female pug, presented for reassessment of left eye following recent left tooth root abscess causing severe swelling of left cheek area. O was applying VitAPos eye ointment since Monday, on Thursday O noticed intermittent squinting and rubbing at the L eye.

Historical Conditions:
- Recent dental extractions (5 teeth including left upper molars 1 and 2, right lower canine and additional teeth) following tooth root abscess
- Left eyelid droop noted post-operatively attributed to pressure from abscess-related swelling
- Splenic mass identified on previous abdominal ultrasound, scheduled for splenectomy next week pending coagulation profile
- Previous urinary crystals causing severe infection
- Right eye ulcer in 2023 (healed well)
- Left eyelid blocked meibomian gland (chalazion) in 2023

Current Meds:
- VitA-POS eye ointment BID to left eye (started Monday, discontinued Thursday due to irritation)
- Ear cleaner once weekly as per WAVES dermatology
- Urinary diet for previous urinary crystals
Eyes:
- Watery discharge from left eye starting Thursday
- Blepharospasm and eye rubbing since Thursday

EXAM
Behavioural: Cooperative during examination, accepted treats
Eyes: Left eye blepharospasm present. Left lower eyelid thicker than right, with mild ectropion exposing conjunctival tissue intermittently. White corneal opacity noted on ventral aspect of left cornea. Left pupil smaller than right pupil at rest. Watery discharge present since Thursday. Right eye normal
Oral: Recent dental extractions healing appropriately
Diagnostics: Fluorescein stain - no active uptake on corneal opacity. Intraocular pressure: right eye 6-7 mmHg, left eye 15-20 mmHg (average 16 mmHg).
Dr. CS examined eye. Corneal surface appears unhealthy stroma. Alcaine applied. Cotton tip debridement removed surface poorly adhered epithelium. Diamond tip debridement performed on left corneal surface - loose epithelium easily removed, indicating unhealthy corneal surface requiring stimulation for proper healing

ASSESSMENT
Left eye corneal epithelial defect with loose, non-adherent epithelium - likely cause of blepharospasm and discomfort. Corneal opacity represents area of compromised healing typical in brachycephalic breeds. Mild pressure elevation and pupil size difference consistent with ocular inflammation.

PLAN
Medications/Treatments:
- Diamond tip corneal debridement performed today to stimulate healthy epithelial adhesion
- Buprenorphine injection SC administered for post-procedure pain relief (will cause sleepiness for 8 hours)
- Ocuflox antibiotic eye drops 4 times daily to left eye
- Optix Care lubricating eye drops (5 vials) - one drop before bed, each vial may last 1-2 applications
- E-collar dispensed - must wear continuously to prevent rubbing (minimum 7-10 days)

New Meds/Tx:
- Gabapentin 100mg BID-TID for pain relief
- Additional 15mL bottle of Meloxicam dispensed 

Additional Discussion:
- Expect increased soreness and blepharospasm for 1-2 days post-debridement
- If no improvement or worsening occurs, corneal grafting surgery may be required
- Procedure should not interfere with scheduled spleen surgery next week

Client Comms:
- Monitor for worsening pain, increased redness, cloudiness, or persistent blepharospasm beyond 48 hours
- Contact clinic immediately if eye symptoms worsen over weekend

Medications:

Eye Drops:

Ocuflox Eye Drop - Antibiotic Drop
Apply 1 drop to the LEFT eye 4x daily, until otherwise advised. 
- Antibiotic. For external use only.

10 minutes:

Optix Care - Eye Lubrication x 5 vials
Instill 1 drop to the LEFT eye ONCE DAILY, until finished. 
Apply before bedtime. 
Next dose due Thursday evening before bed.

Oral Medication:

Gabapentin 100mg x 30 Capsules - Pain Relief Capsule
Give 1 - 2 capsules by mouth TWICE (or 3x) DAILY, as required for pain relief. 
May cause mild sedation. 
Next dose due Thursday lunch & dinner.

Meloxicam Dog Oral 15ml - Anti-inflammatory Liquid
Give to the 7kg mark on provided syringe  ONCE daily on or immediately after main meal
Anti-inflammatory - stop if diarrhoea, vomiting or anorexia

Plan:
Please keep the e-collar on at all times, to ensure no rubbing at the eye. 
Please monitor for any ongoing squinting, redness, 'cloudiness', or pain associated with her eye. 
Please book an eye revisit next Monday/Tuesday based on how she goes over the weekend.