C09998386 / invoice 10000

Appointment Notes: Unable to open his eyes (nic)Luke frequents walking trails and a family farm, going at least weekly. He went on a hike recently and today Barbara noticed he was reluctant to open his eyes, seemed sore.She wondered if this could be a reaction tohe metronidazole medication he is currently taking for Clostridial infection. I explained s/effects generally neurological, so head tilts, nystagmus, circling, seizures etc not ophthalmic.BAR, nice boy and actually more friendly to me today, warming up really nicely.Eyes- R eye partial squint, mild blepharospasm, L eye intermittent squint, no bledpharospasm. Both eyes mildly redenned sclera, conjunctiva. No FB visible in either eye, has not been scratching madly at eyes or rubbing face according to O. Yellow purulent discharge at medial canthus R eye.Fluorescein stain negative both eyes. Hard flush after with saline, no FB located.  Globe otherwise looks normal, no corneal oedema or other abnormality obvious.PLAN:Metacam PO SID 5d- no longer as also treating D+ at present- O to call if this worsensAmacin BID each eye for 7 daysBarbara understands to phone asap if noticing pain seems worse, more squint, more discharge etc.Otherwise I'll touch base on Monday/Tuesday and see how things are going with eyes and D+. Can r/o sneaky FB so if things worsen, expect corneal ulceration and will need sedation and thorough check from there.    Vital Signs    Weight: 45.6;       MMColour: Pink;       HeartRate: 124;       BodyScore: 6;       DentalGrade: 0;       PainScore: 1;       CRT: < 2 sec;