Corneal Ulcer Follow-Up

On June 1st at 9am, I attended my ophthalmology appointment at Sunnybrook, where I was examined and discharged within one hour. Impressively timely, I thought. I was seen by a resident with the worst communication skills and demeanor I have ever experienced in a sub-specialty physician. He diagnosed a bacterial corneal ulcer after careful examination using a slit lamp microscope. Special types of eye drops containing dye, such as fluorescein, were instilled to highlight the ulcer, making it easier to detect. The corneal ulcer was vigorously cultured via three separate scrapings, and smears were obtained using a metal instrument sterilized each instance over a Bic lighter. Dropping the instrument on the ground prior to the first scraping, coupled with his poor bedside manner, did not instill the greatest of confidence.

The staff ophthalmologist (Dr. C. Birt) came in to examine my eyes briefly, and stated that I had corneal scarring on my left eye, and that I would likely have corneal scarring on my right eye after the ulcer healed. She instructed me not to go swimming over the next few weeks and explained that typical corneal ulceration begins with pain (aggravated by blinking), followed by increased tearing. Eventually, central corneal ulceration produces pronounced visual blurring. This explained why I had difficulty seeing objects clearly over the past few weeks. A hypopyon (accumulation of white cells or pus in the anterior chamber) may produce cloudiness or color change. She stated that corneal ulcers may heal with treatment, but they may leave a cloudy scar that impairs vision. Other complications may include deep-seated infection, perforation of the cornea, displacement of the iris, and destruction of the eye.

The examining resident made no effort to explain the diagnosis, prognosis, or treatment of a corneal ulcer, and every question I asked was responded to in a hasty manner, as if I interrupted some critical thought pattern. After prescribing me two strong ophthalmic broad-spectrum antibiotics ([1]tobramycin mixed with gentamicin; and [2] fortified vancomycin) to instill every 30 minutes (even throughout the night), he then instructed me to return two days later for follow up. I was reminded that corneal ulcers are an emergency and that I needed to be treated immediately with frequent follow up.

I returned June 3rd at 10am for my second specialist appointment. Apparently, he told all of his other patients to return at the same time. I was not seen until after 2pm. It was apparent that he was incompetent at scheduling his patients as well. The waiting area was awash with complaints as result of his scheduling-handicap. I was relieved at my chance to wait in the examining room. There, I observed patient records ripped in half and tossed in the garbage (an obvious breech of privacy). On the back of the door hung another resident's lab coat with his Sunnybrook identification tag attached (an obvious disregard for internal security). Lucky for them, I was an honest girl; however, I was tempted to take the ripped patient report and the resident identification and mail them to the hospital CEO with a note attached voicing my concerns about the accesibility of these two articles to the public. When the ophthalmology resident did see me in the examining room, he had misplaced my chart, and had not followed up on my culture results. He assured me that he would phone me with the results (which has not happened yet). He examined my eye and assured me that it had improved. I feel like I have glass shards under my eye lid, and I can barely open my right eye related to the photophobia; a note of improvement was a good sign. Fortunately, I can now instill my eye drops every 2 hours during the day and every 4 hours at night. He also requested I return for follow up on June 5th.