C10027794 / invoice 10000

Reason: Recheck Eye - LBAppointment Notes: JB clientcl.Client Concern: History: checked last on Monday. Bec is applying all meds at home, doesn't think there has been much improvement. Diarrhoea is better. Has been giving the doxycycline again. Physical Examination: Looks much the same as Monday. Contact lens is gone - must have come out of the eye. Possibly slight reduction in size of the ulcer? Stained with fluoroscein - there is definitely a dead edge of corneal tissue again that is underrun. Plan: discussed with Bec - still non-healing due to dead edge of cornea. Options - refer to opthalmologist, or we can try again to debride, and possibly do third eyelid flap. Bec opted for us to try again, concerned that there might be a delay in getting into an opthalmologist (did explain that she could likely get in quicky if she was to go to Sydney).   Treatment: Gave IM sedation 0.15ml medetomidine = 10mcg/kg and 0.35ml = 0.25mg/kg butorphanol. Placed IV catheter, applied more topical local anaesthetic and debrided edges thoroughly with cotton buds - lots of dead tissue came away, especially at ventral and medial margin - suspect this was perhaps hard to do thoroughly last time with her awake. Grid keratotomy performed. Applied tricin to cornea. Performed third eyelid flap to protect cornea. Sutured over a piece of drip line. Plan: leave third eyelid flap in place for 4-5 days and recheck mid next week. Continue applying tricin and other a/b drops, but not serum drops. Continue doxycycline also. Recall/Revisit/Remind:    Vital Signs