Transcript

Will: [00:00:00] Knock, knock,

knock, knock. Hi.

Hello everybody. Welcome to Knock, knock Eye with me, your host, Dr. Glaucomflecken. Thank you for joining me. Uh, your one-stop shop here, uh, for all things eyeballs. I’m just coming off a week of call and it was predictably pretty. Benign. I do not have many malignant call weeks anymore. It’s always pretty benign.

And so, and I feel safe saying that now as I have one more night to go and, uh, famous last words. But, uh, so far it’s been, uh, just fine. I don’t really have much to report to be honest. Uh, I, um. Had to field a couple phone calls. I actually did go to a hospital on a Sunday in the middle of the day, and I made a TikTok about it, [00:01:00] uh, because I knew that people probably wouldn’t believe me that I was an ophthalmologist.

And I came in to see a patient on the weekend to a hospital. It had been a while since I’ve been in, in a, in a hospital. I will say. Um, smells a little funny in there, you know, there’s lots of beeping. It’s very noisy. And those kind of things you, you forget about, you don’t, you don’t recognize them as, as, as much.

It’s like, so when you’re back in that environment, it’s like, some of that came back to me, but it’s like, man, like this is, uh, it’s a sensory overload experience. Hospitals are, uh, for sure. And that’s, that’s as someone who like just was there to work much less a patient like. Man. Yeah, it’s, it was a little rough, but, uh, patients are doing fine.

So anyway, but I’m not gonna talk a much about call. Uh, uh, I, I, here’s, here’s the rundown. Here’s the rundown for today. I wanna talk about this New York Times article that’s, that’s, that made some [00:02:00] waves on medical, social media over the past couple weeks about organ donation and organ. Procurement organizations, these OPOs.

And then, uh, we’re gonna talk about neonatal conjunctivitis because, uh, also I saw something on social media that was a bit disturbing to me, so I, I thought I’d, I’d address that. That’s gonna be our big ophthalmology topic, and then we’ll handle a couple of questions that came in. Uh, first things, uh, uh, uh, before we get to that though, uh, I, in, in the last published video, I talked about how I really wanted to get, uh, Dr.

Elizabeth Potter on the podcast. Well, guess what? Yesterday? We just recorded an interview, so we got to connect with her. Oh, she’s so great. She’s so great, uh, uh, in conversation, just getting into everything that’s happened to her and her practice, and UnitedHealthcare. Uh, we just, it, it just, uh, we just sat there and, and just made fun of UnitedHealthcare for a [00:03:00] while.

I think you’re gonna enjoy that one. So be looking, uh, for that on the YouTube channel or wherever you listen to podcasts. Uh, should be coming out, uh, you know, within the next couple weeks or so. Uh, okay, so Organ Procurement Organizations, the New York Times article. So this, I, I, I became aware of this as I sometimes do, just seeing reactions to it on social media.

Uh, and so, and it was interesting before I was able to read the article, I, I just, I saw several videos on TikTok and universally it seemed that the healthcare. Professionals, the mainly physicians. That’s who I end up seeing a lot of on social media, on TikTok. Uh, were, uh, pretty much roundly dismissed this article saying it’s, it’s gonna lead to people not wanting to get, uh, be organ donors.

It’s going to, uh, negatively impact. [00:04:00] The already scarce nature of, of available organs for donation. Like we have a, there’s a crisis of organs available right now, uh, and that’s been going on for, for quite a while. And so a, a lot of people were just very unhappy with this article. So before I read it, I kind of had that bias in my mind.

Um, and then I read the article and, and, and a lot of the. The, and I encourage, I encourage you to go read it. Just, just Google New York Times organ donation. It’s gonna come up, it was just published, um, earlier in July. And a lot of the, the complaints about it from medical professionals, from physicians was, well, it’s, it’s, uh, you know, they.

They kind of used like a lot of clickbaity headlines and some of the, the other organizations outside of New York Times that shared this story, Washington Post Guardian, all these, they did, and that’s what they do. They use Click Beatty headlines. They use [00:05:00] clickbait. Because they want you to click on it.

Right? That’s how they make their money. And so, um, and so, and then some of them were very like fear mongering, like, you know, uh, people, you know, I, I don’t want to give any examples, but, but you, you got that sense just from reading the headlines on social media that was like, oh. Maybe I shouldn’t be an organ donor.

And I think that initially rubbed a lot of people the wrong way. I didn’t like that. ’cause I did see some of those headlines like, oh, this, I kind of had that, that that kind of a cringe like, ooh, uh, this is, this might not be a good thing. ’cause I know how important organ donation is, not only just in ophthalmology because we get, you know, we do a corneal transplants using donor tissue.

But, but hearts, lungs, kidneys, livers, I mean, it’s, it’s uh, it’s such an important and a vital part of our healthcare system, uh, that saves a lot of lives. There’s roughly 40,000 donations that happen like every year somewhere on in that, [00:06:00] in that range. And so you see these headlines that make it, make you seem, make it seem like uhoh people, uh, doctors are like, are killing patients.

Hospitals are letting people die when they could save them, uh, in order to harvest their organs. Like these are the types of, of headlines that you’re seeing before you even read the article. So I do think a lot of the reactions from healthcare professionals were like, maybe even people that didn’t read the actual article.

Uh, because once you actually get into what the article is. It wasn’t as bad as I was expecting. Uh, one of the big arguments against this article and how it was framed was that there’s lots of just anecdotal evidence. That there’s wrongdoing and some of the wrongdoing is, you know, there was like a story of a, a patient who, um, had some seemingly purposeful movements, yet was still taken off a ventilator and died, and then the organs were, were taken [00:07:00] out.

Um, there was, uh, another story of someone who was just about to be, you know, let go. And made a miraculous recovery that was very close to just, you know, being an organ donor, but ended up surviving. And so in these stories, they, they do make the whole organ transplant system look pretty bad. Uh, a couple things I wish this story in the New York Times did a little bit better was really focus in on these organ procurement organizations.

Because one of the, uh, and they did talk about these organizations, but it seems like there might be an issue there. And one thing they, they just kind of mentioned in passing, which I thought was like, it kind of raised my eyebrows. Was that, um, a while back, I think it might have been Trump’s first term.

I’m not exactly sure when it was, but, uh. They, the federal government [00:08:00] recognized HHS recognized, oh, we’ve got a, a, a critical shortage of organs of organ transplants. Um, and so, uh, what they did was they, they established this incentive system that were pitting these nonprofit OPOs organ procurement organizations against each other for federal contracts to procure organs.

And I don’t know, like competition can be good in some things. I’m not so sure that competition. Get the most human organs is necessarily a good thing. And so that was like, whoa, hold on a second. Like this. And they kind of glossed over that a little bit. Like, okay. So the federal government has these contracts for organizations to, to that, to allow them to function in this space of obtaining organs from patients who have died.

And, uh, [00:09:00] and, and you’re telling me that the federal, in order to get more organs. They had them compete with each other. And, and so you can, you can totally see how there might be, uh, some less than ethical decisions that might happen within these organizations in the quest to obtain those federal contracts.

Right? Like that’s, that’s like, that’s a kind of a hair on the back of your neck kind of thing. Like, Ooh, I, I don’t think that’s a, a good thing. And one thing that also really struck me was the. The separation between the medical, um, decision making, the doctors, the nurses, all that stuff happening with the patient.

And then separately, these organ procurement organizations that come in and they very much feel, seem like separate things. Like you have, you have surgeons working for the OPOs. That don’t work for the hospital, right? So they, they come in [00:10:00] whenever they’re, they’re called. And so there’s a very much a, a, a distinct difference between these two segments of the healthcare system, the doctor’s taking care of the patient while they’re alive, and then the team that procures the organs.

Uh, and so, uh, uh, it’s, and so to, to read this article and then. And, and say that, oh, it’s the doctors that were, you know, or the team was, were, were just letting patients die. I don’t believe that for a second. Like, that does not happen, folks like, don’t believe. And now there was some like inflammatory comments about, like, I, I, I was seeing on social media that that was what was happening.

But the article does not say that some of the clickbait alludes to that possibility. But that’s why you read the articles on stuff like this. But here’s where I, I feel like I differ from a lot of the influencers, medical content creators, the physicians who were reacting to this story when it came out, [00:11:00] who were vehemently opposed to it and wanted it taken down, wanted it.

That story removed from the internet and one of the big complaints. Uh, in addition to the things I’ve already talked about is that these, these were anecdotes, like this does not represent organ donation as a whole, which yes, I agree with, but I don’t think that’s a reason to take an investigative journalism story down from the internet.

Just because something is anecdotal doesn’t make it untrue. All that means is that you cannot take that anecdotal evidence and generalize it to the entire field, the entire, uh, group of cases of organ donation. You can’t say, oh, that patient, uh, is actually, might have been alive whenever they died and had their don, their organs [00:12:00] taken.

You can’t take that one case and say, well, that must be happening everywhere. Can’t do that. That’s, that’s the limit of anecdotal evidence. But you see an an, an anecdote in some, in some investigative journalism, you can’t say, oh, you shouldn’t say that. It, it’s a story. It happened. There are people. Who attest to that?

They put their names behind that story, their credentials. It’s in the article. Look at it. So I, I don’t agree with the idea that we just need to roundly dismiss this as anecdotal evidence. No, you can report that it happened, but you do need to make it clear that this does not mean it’s representative of organ donation as a whole.

Because when you add it all up in this story, there was like maybe five or six. Cases they talked about. And there, there, there may likely be more of, of, um, unethical practices of very questionable acts that were done in the name of organ [00:13:00] donation. But again, 40,000 transplants are performed around this country at least every year.

And so, uh, it, it’s still, I am still an organ donor, and you get, you do have people that are gonna see this story or at least see the headlines and be like, I’m not an, I’m taking that off my driver’s license. I saw those comments on social media. I think that is believing some of the headlines, not reading the actual article and not understanding an anecdote versus evidence-based decisions.

That you can generalize to the whole, the whole area of organ transplant. So, you know, there are things I wish it did better this article, um, but I, I mean, I’m glad it’s out there, right? Because maybe we do need to look at these organ procurement organizations a little bit closer. Not, let not get rid of them, but man, [00:14:00] if they’re doing some things they shouldn’t be doing, like wouldn’t I want, I would want some oversight.

That’s what I’m saying, like, let’s just get some oversight into this. Make sure things that are supposed to be happening are actually happening correctly. That’s what I take away from this, and that’s what I hope other people take away from it as well. Uh, anyway, that’s, those are my thoughts on this, uh, organ transplant thing.

Let’s take a break.

Hey, Kristin. Yeah. There’s this podcast that’s every clinician should listen to. Ooh, 

Kristin: what is it? Yeah. It’s 

Will: called the Sepsis Spectrum. 

Kristin: Mm. 

Will: It’s all about sepsis. Mm-hmm. Which is a really important topic. That 

Kristin: sounds like a big deal. 

Will: It is. And, and it’s, it’s not just like fluff and, you know, your typical ce. Mm.

Uh, this is, it’s like gripping narratives. 

Kristin: Ooh. I love a gripping narrative. Yeah. It’s 

Will: fascinating to listen to and, and so you’re having fun listening to it and learning. 

Kristin: Gripping narrative and ce. Yeah, we don’t hear those two things often. S sepsis together. The 

Will: SSIS spectrum by sepsis alliance and [00:15:00] critical care educator, Nicole Kic.

You can listen to the sepsis spectrum wherever you get your podcast or watch it on Sepsis Alliance’s YouTube channel. To learn about how you can earn free nursing CE credits just by listening. Visit sepsis podcast.org.

I had love to hear what, um, what you guys have to think. If you read that article again, just Google New York Times, uh, organ transplant. There might, it might be, I was, I had to make an account on New York Times to like, I didn’t have to pay anything, but I had to make an account in order to just. To read the article, so you might have to do that, but I would be interested to hear what other people think.

’cause I, you know, if you disagree with me, if you agree with me, let me know. Um, uh, um, leave a comment on our YouTube channel at Glaucomfleckens. All right. I, I usually try to get to those. Okay, so that’s enough about organ transplants. What an amazing thing though. Organ transplants are God, the cornea, like the, the, the little, the small amount of tissue that you get, uh, from a [00:16:00] donor cornea and, and it can take someone from blindness to seeing 2020 again.

It’s, it’s incredible what we can do. I’m not gonna speak to other, I assume hearts are helpful too. In some way. I don’t know, I’m an ophthalmologist, but I can tell you that the cornea tissue, uh, does a bang up job of really, uh, helping with a lot of different corneal disorders. Uh, okay. So let’s talk about, uh, neonatal conjunctivitis.

Our big ophthalmology topic of the day, and I’ll tell you, lemme give you some context to why I am choosing to talk about this today, is because you guys know I’m online, I’m on social media too much. I do too much of it. And occasionally I come across some people that are doing bad things. And, um, in this, uh, in this situation, it was a, um, a wellness influencer slash coach slash teacher.

I think all three of them were used in the description of this person. [00:17:00] They were, I wanna say, a, an. An F-N-P-A-D-A-D-N-P, I think it was. Um, or maybe it was FNP, like a family nurse practitioner. Uh, and, um, but they called themselves like, they’re, like, they run like a wellness clinic. I, so I’m not, I’m not sure the background of this person, but I, I flipped through a few of her, uh, a few of her video flipped through, scrolled through.

I tried not to do things that make me sound ancient. Uh, scroll through some of her videos and one caught my eye. Which was, um, about erythromycin and this person was vehemently opposed to any parent using erythromycin or allowing medical professionals to administer erythromycin to ointment, uh, to your, their newborn babies.

This is, obviously I disagree with this, and so let’s talk about it. Okay. First of [00:18:00] all, this particular wellness influencer, um, had, uh, uh, did not talk about, uh, erythromycin as an ointment. Uh, she mentioned it as erythromycin eye drops, which is my first clue. Like that’s a small thing and in the end it doesn’t really matter, but, um.

Erythromycin is an ointment. It is not an eye drop. And so what that does is it tells me you really don’t know much about these medications. Uh, and so your credibility has already taken a bit of a hit. When you call erythromycin in an eye drop, it’s very clearly an ointment, just like toothpaste. You push it out of a tube, you do not drop it from a bottle.

Alright? So neonatal conjunctivitis, uh, it’s defined as con conjunctival, inflammation. That occurs within the first 30 days of life. And there’s different types. The main types of, of neonatal conjunctivitis that you’ll hear about is a chemical conjunctivitis, which we don’t see as much anymore. We saw [00:19:00] that a lot when, when babies would get, uh, newborns would get, um, uh, silver nitrate as a prophylaxis.

Uh, but we don’t use silver nitrate anymore because it is very caustic to the surface of the eye. You can get a big inflammatory reaction from that. And so in the, instead we do, uh, an antibiotic, which we have a lot of evidence that works called erythromycin. It’s a macrolide antibiotic. And what happens is soon, shortly after the baby comes out of the vaginal canal, they just put a thin strip of it kinda right.

On the, the, the surface of the eye on both sides. It kind of opened the baby’s eyes just a little bit and put a, just a little bit right there, just a thin strip. Baby’s eyes are very small. You don’t need a lot of this medication, and the reason that is done is because of the risk of gonorrhea and chlamydia that newborns can get exposed to as they go through the birth [00:20:00] canal.

A a, a patient who is infected and a woman who’s infected. So, um, so the erythromycin does a great job. It has broad spectrum coverage and it can take care of some of the bacteria that might, might get on the baby’s face and their eyes. And the reason we do that is because conjunctiva, or sorry, chlamydia conjunctivitis and gonorrhea conjunctivitis both cause a pretty explosive.

Mu muco, purulent discharge and, and, and swelling of the eyes and uh, uh, and redness and potentially scarring. You can get corneal scarring, particularly with chlamydia if it’s not treated quick enough, and so you do the erythromycin ointment so that you don’t have to potentially have the baby have to take like oral or systemic antibiotics.

For a week or two because [00:21:00] not only can chla the bacteria get in the eyes, but there are cases of babies also getting pneumonia from chlamydia. And so we’re not talking just the eyes. This can, that’s why it’s so easy just to prophylax against it with a little erythromycin appointment in the eyes because the alternative of having to treat a newborn with gonorrhea or chlamydia is potentially devastating.

Not the treatment but the disease. All right, we’re talking Blindness can get blindness. Now, this influencer first started talking about how the dangers of erythromycin. Erythromycin itself can cause blindness, which is absolutely absurd. Even if you are a, if you have an allergy to erythromycin, like the worst it’s gonna do is it’s gonna cause you to have some redness.

You’re gonna get lots of itching, maybe some hives around the eye, but it’s not [00:22:00] gonna make you go blind. Alright? And you’ll notice that there’s something wrong and you’ll just stop taking it. But this is just a one-time application. To the baby’s eyes. And we have studies that show that, um, that the effectiveness of, of, of this.

And so it’s, it’s a safe medication and it, and it’s effective. And if it can prevent blindness, great. You’re not gonna go blind from erythromycin. That’s not gonna happen. Um. Another big argument would be, uh, that, that, that this, uh, this person and other, I mean, she’s not the only one like this, this wellness person.

This is, this is a very common, it is like, don’t, don’t give your baby your newborn vitamin K. Don’t give them, by the way, I personally don’t really like, uh, newborns with int or cerebral hemorrhage. So, you know, you know, yeah. Don’t do vitamin K if you don’t want to, I guess, but, but you’re, you’re preventing a potentially deadly complication.

Uh, and [00:23:00] so, uh, vitamin K is a common one and, um, uh, and the erythromycin ointment, and I know, uh, Jen Hamilton on on TikTok, she’s done some great, she’s an OB nurse. Uh, she’s done some great content around these issues. It just, those are the types of content creators I want to hear about, uh, uh, that have that firsthand experience and can give that kind of context.

Lots of pediatricians, obstetric. Like there, there’s, there’s good medical content creators out there, you guys that have some expertise, that have some experience in, in this stuff. I encourage you to seek them out and maybe I’ll create a list one day. I don’t know. But, um, anyway, so, uh, what, what, what are some of the other claims, uh, from this content creator?

Oh, here’s one, um, that, uh, that you don’t even need the prophylactic antibiotic. Because all moms are tested. They’re tested for chlamydia and gonorrhea, which is true, that is [00:24:00] considered routine screening in the third trimester is, uh, to, to test for chlamydia and gonorrhea. Now, now here’s, here’s one of the problems is that those tests are not infallible.

There’s a few problems, but here’s one that. We know that there is a potential for, um, false negatives with these medications. So false negative rates can be, and this, I’m reading this, this is, um, a study that, uh, let me, let me find it. Uh, that was published in JAMA in 2021, um, that looked at screening for chlamydia, andal infections, and the big takeaway from this.

False negative rates can be as high as 10% for gonorrhea testing and 28% for chlamydia testing. So testing is great because yeah, if [00:25:00] someone, if someone has untreated undiagnosed gonorrhea and chlamydia, I don’t care if they’re pregnant or not. Like patient needs to know that. And so, so I am all for testing.

That’s great. Uh, but these, the, the potential for a false negative. Is is concerning enough that, I don’t think that’s a, a valid argument that we test, we screen if the tests are negative. No need to prophylax the baby. I don’t buy that because there is the potential for false negatives and the, the potential risk of doing the prophylaxis is so incredibly low.

It is safe that there’s really, the risk benefit profile is skewed heavily in favor of benefit. So you gotta think about the possibility of false negatives. Alright? Creators like this, wellness influences like this. They, they, they say these things in absolutes. Like, oh, screening’s done, the disease doesn’t exist, [00:26:00] no need for prophy prophylaxis.

That, that demonstrates a lack of understanding of how screening exams, how testing works. Like the human body is not a computer. These tests are not infallible. Right. So, so you have to take that into consideration when you’re assessing risk. Uh, another claim is that, um, well also if you’re getting a c-section, you know, you don’t, you don’t need to, you don’t need to prophylax.

Well, that depends on some factors. Yeah. I, I understand the, the, the, the reasoning there is that if the baby’s not going through the birth canal, you know, there’s no risk of. Of, uh, collecting any bacteria in the eyes. But that depends on, you know, how long were the membranes ruptured, you know, because you can have migration of that bacteria, you know, into the uterus.

From the vaginal canal, [00:27:00] especially if there’s, uh, if, if the, the membranes are ruptured for 24 hours, you know, it, it, it, it can happen. And so, and again, the risk of prophylaxis is so low. Just do it. It’s, it’s, there’s no downside to it. All right. The worst that can happen. For, for, for getting erythromycin ointment.

A thin strip of it on a baby’s eyelids is you could get a little bit of, of, of redness. You could get a little bit of, um, a, a little bit of swelling, but it’s nothing compared to what you would see in an actual infection of, of, um, of chlamydia or gonorrhea. Okay. So that’s why every reputable board organization having to do with, with.

With labor and delivery and pediatrics recommends this, ophthalmologists, okay, I don’t wanna belabor the point, but like it, this is important. This is the important stuff. We don’t wanna see [00:28:00] babies with neonatal con, uh, you know, chlamydia and gonorrhea. We don’t want that all because someone was not informed.

And, and, and I placed no blame on the, the, the, the mothers who listen to these people because they’re just. They don’t have the knowledge, they don’t have the background, and there it’s easy to believe someone speaking confidently on social media about things they don’t understand. I place all the blame on these, these wellness influencers who portray themselves as experts, who clearly don’t understand the data behind what they’re, what they’re recommending or not recommending.

So anyway, um, oh, here’s another one. Here’s another one. Here’s another thing. I, so I started doing a little Googling around and, and, um, you know, you just, you just Google, uh, uh, you know, newborn erythromycin and Oh man, you’re, you’re gonna [00:29:00] find some things. All right. Uh, so I came across some websites, and here’s another, um, uh, argument against erythromycin ointment for a newborn that I kept coming across is that it prevents, um.

It prevents the ability of the baby to bond with mom because you’re making the vision blurry. You’re basically inducing blindness from ointment. So this is, this is really, this is where my expertise really kicks in because do you have any idea what a baby’s, what a newborn’s vision is at the time of erythromycin ointment Application lights and shadows.

It’s, it’s at best, at best if a, if a newborn could, could like talk and interact with you, they would see 2,400 at best. You go right now, you go put some ointment in your eye. I guarantee [00:30:00] you you’re seeing better than 2,400. It’s gonna be blurry. You’re not gonna see as well, but you’ll make out more than a newborn would.

So the argument that it, it, it affects the vision so much that the baby like can’t find the breast to breastfeed, can’t like, like the baby’s staggering around trying to like feel around for, come on, what are we doing here? But this is an argument that people use to sway worried moms. A away from evidence-based medicine, stuff like this.

By the way, your, the vision improves dramatically by the first month of life. Things are looking a lot better, but, uh, newborn babies, when they’re, they’re, they see mostly shadows, mostly like light and dark white, black and white. Um, not gonna make anything clearly, 2,400 at best. And also, they’re not gonna have binocular vision.

That’s why if you, if you, uh, I’m sure you know, those of you who have had a baby, uh, can, can [00:31:00] attest to this sometimes right off the bat, the eyes are a little bit googly. You get these newborn googly eyes. It’s very cute. It’s very cute. And eventually the eyes will, once the, you know, the eyes are open and moving around and, and, uh, and accepting visual stimuli, they start to.

Come together and move in tandem like they’re supposed to. Alright, so that’s, that’s, that’s, that’s erythromycin. In short, it’s a extremely low risk, high reward intervention that can prevent blinding conditions. The U-S-P-S-T-F also recommends it. The other big neonatal conjunctivitis cause uh, that we, that we see sometimes is, is herpes.

HSV, oh, by the way, also the screen. How about going back to like, uh, the screening thing? Not every mother gets screened, you know, uh, uh, uh, [00:32:00] prenatal care can be very hit or miss, and so sometimes you don’t know. How effective this, the, the prenatal care was or what was done, or can you trust her? Do you have the records or does the mom even know what was screened or what was not screened?

And so, um, and so that, that’s another reason that you, you would wanna do it, is that maybe you don’t know if, if the mom was tested for chlamydia or gonorrhea. Anyway, so, uh, the, the last thing is HSV, which, uh, if, if, if there’s neonatal HSV, then that’ll present about, you know, one to two weeks after birth.

And, um, you know, if, if a baby, if a newborn does get these diseases, you know, treatment, as I mentioned, uh, for the chlamydia conjunctivitis, usually oral azithromycin, uh, because you know, you have to, you know. Treat possible pneumonia as well, if that, that might be a possibility. Um.[00:33:00] 

Conjunctivitis, which is nasty stuff. Now I’ve seen a couple cases in my career of neonatal gonorrhea and, uh, the amount of discharge just pours like you. It’s incredible. This does, this bacteria, ria gonorrhea is nasty. You clean out the, the, the, the, the purulent discharge. I mean, it’s gross, but you clean out the purulent discharge and within three minutes.

The eye is goopy. Again, it’s that much inflammation is happening. You don’t want a baby to get this, you don’t want anybody to get this. But, uh, um, anyway, so you require lots of irrigation to get all, a lot of the discharge. If, if you see this disease. And then systemic treatment is, is really, you know, required.

You got probably about seven to 14 days, one to two weeks of systemic, uh, antibiotics. And, um, all neonates with gynecological conjunctivitis, you gotta also treat them for chlamydia. There’s some overlap [00:34:00] with that, but you have to, you have to treat, uh, uh, both diseases as well as the mother as well as the sexual partner.

Everybody’s getting treated. We’re all getting treated for gonorrhea HSV Keratoconjunctivitis, uh, in a neonate IV acyclovir, and that’s usually a longer treatment That’s like two to three weeks. Um, that can be a, uh, really bad disease. All of these can be bad. You know, the complications from this stuff is, is corneal edema, corneal opacification, scarring, sometimes perforation of the cornea, endophthalmitis, you can lose your eye.

I’ve seen people who have as adults, they’re blind from these neonatal infections. It can affect the brain, it can affect the central nervous system. You can get meningitis from OC conjunctivitis. I’ve never seen that happen, but I’ve heard about it. Death like this. This is not a benign thing. You know what it is?

Benign applying erythromycin ointment to [00:35:00] the eyelid once. All right. I’m done getting angry. I’m done. I’m sorry. I am sorry. It just, it just, oh, this is why we need, we need trusted voices on social media. People see these things. People see this stuff, and they believe it. They believe it. Misinformation travels so much faster than factual things because it, it, it, it just, it, it ties into.

It. It like reaches people’s natural tendency to like distrust medicine for some reason. I don’t know. I mean, we’ve shot ourselves in the foot time and time again, I think with certain things, but like we’re doing our best. We’re doing our best, so we need trusted voices out there. That’s neonatal conjunctivitis.

Hope that was helpful. Any follow up questions, you can leave them in the YouTube comment section. Happy to, to answer. Uh, any other, anybody have any firsthand knowledge of treating or, or having these [00:36:00] conversations with patients, um, or, and families? Um, it’s a tough one. It’s a tough one. You know, you, you use your experience and your expertise the best you can.

Uh, alright, let’s, let’s do, um, I don’t even know if I took, did I take a second break? Can’t, no, I, I don’t think I did. Let’s take one more break.

All right. Let’s do some questions. I’ve got some answers. You’ve got some questions. All right. Here’s one. Um, I, I love some of these. So this is, uh, I’m looking at the comment section of most recent episode of Knock-Knock Eye that was published. Why did UnitedHealthcare go after Dr. E? Potter. Uh, and um, I had one comment here from at Megan Shag bark 6 8 3 9.

Uh, I’m gonna shorten this comment just a little bit, but one question that I do have about the eyeball speculum. So I talked about, you know, with any, any kinda eye surgery we have to keep the [00:37:00] eyelids open. Or any kind of procedure. And so we will put just like the scary thing in Clockwork Orange. If you’ve seen that movie, it’s a little wire speculum that will hold the eyelids open.

I’m demonstrating on YouTube if you wanna go look at it that just hold, it looks like this. This is what your eye looks like to your eye doctor, but your eye is numb so you don’t see it. I’m gonna look right into the camera. See it? I did good exposure. Now I, I’ve been doing this for about 10 seconds already and my eye’s already starting to burn because it’s getting dry.

Oh, that’s uncomfortable, but fortunately your eye is numb. You might have a little sedation on board as well. So anyway, that’s the eyelid speculum. But the question here from Megan is if that speculum is holding the eyelid open, is there risk of any muscle strain if someone blinks against that speculum?

That is a fantastic question. You are correct actually, one of the risks that we talk about with patients with cataract surgery is the risk of having a droopy eyelid because you have a one big [00:38:00] muscle that’s called the levator muscle that’s responsible for, um, for opening your eye. Well, when we put that wire speculum in, that’s why we wanna numb up the eye and make people make sure they’re, they’re nice and relaxed for surgery.

Because if the patient, you put that eyelid speculum in and they squeeze against that speculum, what’s gonna happen is that speculum is going to stretch out that lator muscle. And if you have a stretched out levator, it’s gonna cause you to have droopiness and that droopiness sometimes, which we call ptosis.

We always gotta add a p to any, any word in ophthalmology, uh, requires surgery to fix. So we do a surgery to, to shorten that muscle, which opens up the eye a little, little bit. So that’s why we don’t want you squeezing against the speculum. I’m always telling people, okay, don’t squeeze, you know, just relax.

Open your eyes. I try not to tell people to relax because I think that sets people off sometimes. Hey, you’re having the eye surgery. Just relax. Just it be easygoing. Don’t [00:39:00] worry about it. I’m just, I’m cutting into your eye. Just relax folks. It’s fine. No, try not to do that. Um, but I, I, I do tell people just to not squeeze and that usually helps.

Uh, I tell people to open your other focus on your other eye. I am not operating on, just open that eye. You can blink if you need to, but don’t squeeze your eyes shut because I don’t want people to end up with a big droopy eyelid. Great question. Um, what are, see this is from at Goer Goblin. Great name. Uh, what are some surprising medical conditions an ophthalmologist may diagnose during an exam?

I have one very amazing, uh, uh, example of this. So I had an attending in, um, in residency. He was a retina doctor and he was known. He was like a world famous big deal. All right. The best. The, the best diagnostician ophthalmologist, like he could, he always knew what was happening, what was [00:40:00] going on. Uh, and there, I remember being in the room, he’s, he’s examining a patient and, uh, I can’t remember if he gave act an actual explanation.

You know, Iowa is a different place. I was, I was at University of Iowa, lots of farmers, you guys, farmers everywhere. And so I’m pretty sure this was a farmer, but he looked inside the eye for a while. And, uh, and he said, can you drop your pants for me? And again, this is like an old school doctor, old school patient, right?

Patient, no big deal. Said this is a farmer guy. Didn’t, he’s like, yeah, he just dropped his pants. Uh, and I was, I was, I was sitting there like, like, why? Like, what the hell is going on right now? This is, you don’t do this in ophthalmology. This is why we became ophthalmologists so we don’t have to examine people without pants on.

He did a little genital exam with a glove on. I do remember that. And then he said, [00:41:00] well, sir, you got syphilis. So my ophthalmology attending. Diagnosed a patient, he looked in his eye, thought it might be syphilis, and then did a, a genital exam and I guess saw like a Shanker or like what, something that you see.

Maybe it was lymphadenopathy, I don’t know. Or giant swollen testicle, who knows? But, uh, I, I don’t remember back that far and I don’t know if I was looking close enough, but, uh, uh, it was able to diagnose syphilis. Uh, that was, that was, that was very, it was impressive. It was very impressive seeing something in the eye and be like, I think that’s probably syphilis.

And then, um, ’cause that’s a hard disease that diagnosed in the eye. It’s a very hard disease. It’s, it’s, uh, one of those masquerading syndromes. It can look like a lot of different things. So anyway, that’s a good example. Uh, and I’ll do one more question here. So at alc 5, 4, 4 0, maybe a dumb question. There are no dumb questions when it comes to ophthalmology.

I’ve asked them all, don’t [00:42:00] worry, but is there a reason em doctors can’t provide bandage contact lenses? So I talked about corneal abrasions and how we have something that emergency doctors don’t have. We have band-aids. It’s a special contact lens you can put on the eye that covers the abrasion. Safely while still allowing it to heal and patient.

It takes away 99% of not, I say nine 90%, we’ll say 90%. 90% of the patient’s pain is gone. It’s a great tool to have. So the question is, why don’t em doctors provide those? Why can’t that happen? It can. I’m not saying it can’t. It’s a matter of cost. ’cause those things, I don’t know how much they are. I wanna say they’re, uh, maybe like 40 bucks for one of a contact lens.

Like that. It’s more about, about stocking them. Uh, and just the cost because, uh, better believe if there’s [00:43:00] any department in a hospital that’s focused on cost, it’s gonna be the emergency department. Alright. Um, and, and so. There. I mean, I, I say that as if I really know the, the, the finances of a hospital. I have to imagine, I think every department in every hospital these days is now focused on cost.

But anyway, um, I, I’ve never seen it happen and I don’t think it will. It’s just not, not something there, you know, putting in, taking out contacts, how to, how to counsel the patient on the best way to take care of it. Like, could they do it? Yeah. Is it the best use of their time? I don’t know, honestly, I’d be okay with it as long as you can get the contact in safely and, and counsel the patient and treat it correctly, uh, I’d be okay with it, but I, I don’t see that ever happening.

It’s, it’s just another thing you gotta keep track of and, and, and trust. I mean, they, most emergency departments don’t even have a functioning to pin or slow [00:44:00] lamp. So I like, you know, I, I picked my battles where I can, and so asking an emergency department to stock bandage contact lenses. Now, maybe I could do it myself.

Like I could just go to my local, like Santa Claus, go to my local emergency department to just like leave a stocking full of bandage contact lenses for them. I haven’t thought about that until this very moment, so I’ll actually think about that a little bit harder and see like what are the barriers to that?

Because I trust my local emergency physicians. They’re fantastic. They’re great. Um. And then last question at Lenovos 9 9 2 6, what is your point? Do you want a compliment that you pushed the button to identify yourself on the plane? As a medical doctor? Dude, really? Uh, yeah. I’m an ophthalmologist. I do want to compliment.

I pushed a button. I did not help, but I pushed that damn button. I was ready and willing. Give a pat on the back. Everyone that is knock, knock. I [00:45:00] thank you so much for listening. I’m your host, will Flanary also know as Dr. Glaucomflecken. Special thanks to my executive producers Aron Port Rob Goldman, Ashanti Brigg, editor engineers Jason Portes.

Our music is by Omer Ben-Zvi. Night Knock High is a human content production. We’ll see you next time everyone.

Goodbye.

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