"The school called this morning and told me that I had to pick Jack up," said Mrs. Brown. "The nurse said that he had pink eye and was not to return to school until it was totally cleared. I figured I would stop by on the way home to see if you could examine him." That explains why she came to the office without an appointment. I told the nurse to put him in a room so I could examine him after my next patient.
As I entered the room I noted the chart reported that the chief complaint was pink eye, with a normal temperature. Mrs. Brown was most appreciative that I would see him on such short notice. Jack was sitting in his school uniform playing Gameboy. Rechecking his chart assured me that he was six years old, although he looked as big as any third grader.
Apparently Jack woke up this morning with slight redness in his right eye. He felt fine and had no real complaints. Mom thought that he might have had an eyelash curl onto the eye when he slept, and this was the cause of the redness. She even put in a few drops of Visine thinking that it would clear up. "I was a little concerned when I dropped him off at school because the redness wasn't any better. He had a little crustiness in the corner of that eye but he didn't have a fever and really felt just fine. So I dropped him off."
Just after lunch she got the call to pick him up. She thought for sure that they were overreacting, but went immediately. Walking into the nurse's office she stopped dead in her tracks. "Oh my gosh," she blurted when she saw her son. "Your eye looks horrible! His eye didn't look anything like this when I took him to school. I will have him seen today." And that is what prompted mom to stop by the office on the way home from the school.
Jack was undaunted by the whole thing, playing his Gameboy as if in another world. His mom made short order of this as she confiscated his valued possession and put it in her purse. He instantly returned to the present and politely jumped up on the examining table. He was very pleasant and cooperative, telling me about first grade and the baseball team that he was on. His examination was completely normal except for the eyes. The right one was bloodshot and red, with a copious yellow discharge that had accumulated in the corner. The eyelashes were matted with a yellow crustiness, and he constantly blinked due to the irritation. His left eye was only slightly bloodshot. I expected that it was just lagging behind and would probably look the same by morning.
Mrs. Brown was told that Jack had conjunctivitis. Because of the purulent drainage and the rapidity with which it spread, it was probably a bacterial infection. I was going to prescribe antibiotic drops. There was silence in the room as mom looked at Jack and he put his head down in a sulk. "Oh, Jack hates to have drops put in his eyes, but we'll manage."
Three days later there was Jack's name on the schedule. This time I was greeted by both of his parents. Dad had the day off and wanted to come to the visit. I commented that this was the first time that I had actually met him. Shaking hands I was struck at how Jack was a miniature of his dad. Not only did he look like him, he was built just like him as well.
Mom explained that the drops were not working at all. His eyes were no better. Should we change antibiotic? Sure enough, his exam was no different from three days earlier with the exception that his left eye was as bad as the right.
I was surprised that Jack hadn't gotten better. These were the very best antibiotic drops currently available, and I wasn't aware of any problems with resistance. Mom assured me that she was administering the drops as prescribed, and swore that she hadn't missed a dose. That is when Jack's father interrupted. "It is absolutely like Wrestle mania to get the drops in his eyes." It all became clear to me what the problem really was.
I asked the parents to put the drops in Jack's eyes, just like they were doing at home. His parents let out a big sigh, and all of the color left Jack's face. "Let's do it," dad said as he stood up behind Jack. Mom nervously took the cap off the bottle and assumed her position to the side. Jack scrunched down in his chair, rigid as a board. He tentatively put his head back and opened his eyes to an opening of a squint. Dad put his big thumb below the eye and with his other thumb tried to pry the eye open. With this, Jack shut his eyes tighter while scooting down in his chair. With a tremulous hand, Jack's mom tried to time it such that a drop of the antibiotic might make it in or near the eye. This exercise took several minutes, and when it was all over, the medicine was rolling down his cheek.
I gave Jack a few minutes to regain his composure and then told him that I was going to put the drops in his eyes. Although a bit apprehensive, he was willing to let me try. Jack was told to lie down on the examining table. He did this with some trepidation. I assured him that I would be doing nothing unpleasant. He was told to shut his eyes as tightly as possible. Fearing what might be coming next, the eyes were shut without hesitation. Taking the antibiotic drops from mom, I dropped two drops in the corner of each eye near the nose. The drops sat there in a little pool. Jack was told that I was going to count to three, then I wanted him to open his eyes as big as possible. "One...Two...Three!" He opened wide and the drops disappeared into his eyes. He sat up and grinned. The parents silently looked at each other; dad put his head down and shook his head. Mom chuckled and said, "I think I'm going to need another prescription for the antibiotic drops since the entire bottle was wasted on his cheeks.