C10001131 / invoice 10000

Reason: Recheck Eye - No BetterAppointment Notes: zzEye seems worse, more squinting and painfulAlso mentioned had some nasal congestion/scabby around nostrilExamine: Ocular: left eye marked blepharospasm ++Small central corneal opacity Marked PLH and glassy dry corneal appearanceSTT L eye <5mm, barely registering any tear productionR eye ~15mm/minPupils even and responsive SNS bilateralIntact palpebral and menace reflex, no facial drooping Fluoro - very faint brush stroke type uptake centrally Resp: left nostril notably dry and crustyAssessment: Suspect for neurogenic keratoconjunctivitis sicca (dry eye) left eye Ddx: autoimmune Plan: Recommend specialist referral to assess further Pilocarpine option for treatment?    Vital Signs    

Reason: Recheck Eye- Looking No Better/ WorseAppointment Notes: HWHistory: Left eye corneal ulcerChlrosi/doxy/meloxicam/ optixSubjective: Mr reports still holdig eye closed at times with increased mucus dischargeExamine: Left eye mild conjunctivitis, and scleral inflammation AC clear Cornea appears clearFluor faint uptake more dorsally nowCentral area from few days ago seems to have resolvedTreatment: Continue current rx as recommended given good responseTears natural added in for added lubrication during the day with optixcare am and pm Saline eye cleanigDoxycyclineMeloxicam antinflammatory OptixCare Eye Lube - Carbomer+ Hyaluron Chlorsig tid Plan: R/v if no betterIf still red or mucus build up then best to check STT next visitPossible contact lens placement if signs of ulceration still present    Vital Signs    Weight: 10.4;