Today i had to have a serious talk with the mother of my patient because since his (my patient) last visit two weeks ago his condition has only gotten worse and as a child i could only blame the mother for letting this get that bad.
@nattybongoMy issue wasn't with the fact that he perhaps didn't get the right diagnosis or treatment or anything like that, but then the mother actually didn't follow the management directives that i gave her from the last time and didn't even use some of the drugs i gave her at all, which really got to me because now the condition of the boy is just that bad.
Bacterial/Vernal Conjunctivitis to Blepharitis
So two weeks ago my patient, a 7 year old boy was brought into my facility accompanied by his mum for care. The chief complaint was that he has been rubbing the eye for as long as the mum could remember but then recently it has gotten quite bad and she felt that the eye's color has changed, he is tearing a lot, always complaining of pain and he wakes up with copious discharges such that she always have to clean the eye every morning.
@nattybongoSo i went ahead to do my preliminary examination, his vision could be subjectively assessed because he was having difficulties reading and comprehending the chart, and i realized that the integrity of the corneal been compromised from the consistent rubbing of the eye. The conjunctiva was much injected and brownish and the cornea picked up fluorescein stains. His intraocular pressures seemed ok though and other parameters seem to be within a good range and so he was diagnosed of vernal conjunctivitis which has been compromised with bacterial infection.
I proceed to give him some topical antibiotics, some drops, some ointments and some systemic treatment to aid the process and he was to come back to be review in two weeks for alteration in medication. The mother was made to understand the condition and the severity and how it could actually get worse he she doesn't pay close attention to him.
Fast forward, today was two weeks since his last visit and the mother came in with the condition being worse than their first time so it made me wonder why that could be so? Turns out the mum didn't use the topical drugs i gave her at all, and for the one she used she didn't instill it in the dosage and frequency stipulated, her rebuttal was that the child keeps fighting her so she stopped outright.
Now the condition has progressed from a simple bacterial infection to blepharitis, the child's lids are involved, the corneal integrity is severely compromised and and eye is worse generally than their first time. And so i had to let her understand how much she is risking the child's sight now by allowing the child to dictate his health, should the healing process affect his vision, he will blame her for the rest of his life because he would obviously say he was a child and naive.
@nattybongoNow he has been given more drugs, both topical and systemics and more instructions to follow, i am hoping to review again in two weeks time with things been a bit better and hopefully both mother and child being more complaint this time round.
The take Home
I believe as parents or guardians it is our sole responsibility to fight for our child's health and care and to demand it where necessary because kids will always be kids and should we allow them to dictate their health we may end up regretting later in the future. Let's put our feet down and stand for their health even if they do not like it because their drugs sting, or doesn't taste so nice or whatever it may be.
@nattybongoIt is better for them to heal and be better that they may say thank you one day than to risk their health altogether to satisfy them. I shared this here so that we may all learn and let it guide us, i do hope that we did get something from it though, as i always say, when in doubt please speak to a professional and do well to avoid self medication as it could be quite dangerous. It was a pleasure serving you, thank you for your time.
Further Reading
Leung, A. K. C., Hon, K. L., Wong, A. H. C., & Wong, A. S. (2018). Bacterial Conjunctivitis in Childhood: Etiology, Clinical Manifestations, Diagnosis, and Management. Recent patents on inflammation & allergy drug discovery, 12(2), 120–127. https://doi.org/10.2174/1872213X12666180129165718.
Jun, J., Bielory, L., & Raizman, M. B. (2008). Vernal conjunctivitis. Immunology and allergy clinics of North America, 28(1), 59–vi. https://doi.org/10.1016/j.iac.2007.12.007.
Bernardes, T. F., & Bonfioli, A. A. (2010). Blepharitis. Seminars in ophthalmology, 25(3), 79–83. https://doi.org/10.3109/08820538.2010.488562.