C10006753 / invoice 10000

Reason: NEW Scratched EyeHistory:Presenting for: Patient presented for suspected eye injury, possibly a scratch or other trauma to the right eye.Current Meds: Trazodone - given intermittently for anxiety/sedation. Gabapentin trialled once but was ineffective.Other: Owner noted the patient's eyes become puffy and third eyelids become more prominent when on Trazodone, particularly at peak effect. Patient also develops epiphora when anxious/stressed.Examination:Behavioural: Cooperative during examination, tolerated ocular procedures well with local anaestheticEyes: Right eye - mild blepharospasm, third eyelid protruding, conjunctival inflammation and swelling particularly at ventral aspect, small scratch noted on eyelid margin. No corneal ulceration detected with fluorescein stain. No bleeding observed. Left eye - unremarkable, no similar inflammation or protrusion of third eyelid.Cardiovascular: Heart rate and rhythm normal on auscultationDiagnostics: Fluorescein stain performed on right eye - negative for corneal ulceration. Topical anaesthetic (local anaesthetic drops) applied to facilitate examination.Assessment:Right eye conjunctivitis - likely secondary to blunt trauma or possible infectious aetiology. No corneal ulceration present.Plan:New Meds/Tx: Opticin (broad spectrum antibiotic eye ointment) - apply 5mm strip to right eye twice daily for 7 daysClient Comms: Advised to monitor for concerning signs including corneal cloudiness or persistent blepharospasm beyond 3 days, which would warrant recheck. Eye condition expected to resolve with antibiotic treatment over 7 days. Explained that Trazodone-related ocular changes (third eyelid prominence, epiphora) are normal side effects of sedation.    Vital Signs    

Reason: Pls Request Hx From Beecroft VetHx requested from beecroft vet.    Vital Signs    Weight: 10.5;