Wednesday, August 13, 2014
What I have been doing this summer
June 25 I got slammed in the R eye with a fishing weight. A tourist ripped his torpedo sinker out of a kelp stringer and into my eye 15 feet behind him. This caused major damage to just about every part of the eye. Bleeding and swelling raised the eye pressure (intraocular pressure) to over 70 mm. Normal IOP is 15 mm. Blood, and vitreous was forced past the lens into the anterior chamber and incidentally further damaging the lens. This pressure also damaged the optic nerve, and collapsed the channels that normally drain the eye and regulate pressure. I was on a sport fishing boat here in Dana Point and we were a few miles from the harbor. The skipper, and his first mate were on the job from the start. They got me a medical evacuation by the Orange County Harbor Patrol within 15 minutes. The Emergency Room docs, and the consulting ophthalmologist all agreed that if I had been delayed even another 1/2 hour from medical attention, I would have lost the eye.
I was hospitalized for 3 days. We then tried for 3 weeks to control the eye pressure medically.
As the massive blood clot broke up over the next few weeks, the MDs could see the damage better. The muscles that control the eye's orientation were damaged, but have recovered function recently. The extent of permanent damage to the optic nerve was fortunately minor, and the retina is still working well. The cornea was scarred, and traumatic cataracts started growing within days. The iris muscles were paralyzed by nerve damage, and then died as pressure blocked their blood supply. The lens was destabilized when a large number of the fibers (called zonules) that hold the lens in place were snapped. It will eventually break free which will require surgery as will the cornea cataracts and scarring. All in all, this sucks. I took 5 meds on various dosing schedules between 6 AM to 10 PM. The main goal was to stabilize my eye pressure back at the normal 15mm.
The purely medical approach failed. Even when the IOP would return to nearly normal, it would next spike back to 2 or 3 times normal. What had happened was that the extreme pressure, and the blow itself had collapsed the eye ducts so badly they could not recover. Finally with my IOP back over 48 mm, we did an emergency surgery on July 16th. The cornea was lifted to clean the anterior chamber, and a shunt was put in to mechanically replace the drain system destroyed by the injury. The recovery time for that surgery is 4 to 6 weeks. We are into the 5th week now, and there has been considerable improvement. However even with additional surgeries my R eye will never regain full normal functioning.
We have maxed out the medical suppression of the eye pressure while the surgery heals. This means various kinds of eye drops - 13 each day administered by my wife every hour or two between 6AM and 10PM. Plus, I have varied between 1,500 and 500 mg of Diamox- one of the weirder drugs in terms of side-effects I have ever had. What we are not using is pain medication since pain is an important clue to the IOP. In fact, it is really the only one readily available without a lot of medical hardware.
The next time I get injured I want better drugs!