NOVEL NEXT Chapter 160
160. Vision Loss (2)
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The Patient was glaring at me with suspicious eyes. Urine is needed for the diagnosis—what am I supposed to do about that? Should I just pretend not to see it?
I stared back at the Patient.
“Not to be rude, but here’s why we need this.”
“Yes?”
“Well, if blood sugar levels are high, your blood can get sticky, potentially clogging blood vessels. This could affect the kidneys, leading to abnormal urine output. It might also damage the delicate blood vessels in the eyes.”
“Hmm…”
“The condition I currently suspect as the cause of your partial blindness is diabetes. It could be making your vision blurry.”
“Diabetes? Isn’t that something only fat noble elders catch? Why would I have it?”
“There are many possible causes.”
This Patient did seem younger than the typical demographic for diabetes, but diabetes isn’t always caused by lifestyle habits alone.
While adult-onset diabetes is common, there are other reasons someone might develop it—genetic predisposition or pancreatitis, for example.
We placed a large bottle of water beside the Patient, who began drinking.
****
Istina tilted her head in confusion.
“So, you really can assess a patient’s condition by tasting their urine? I thought that was superstition.”
“Some people actually do that.”
“But isn’t that unscientific?”
I shook my head slightly. Checking for protein or sugar in urine isn’t unscientific—it’s unsanitary.
A few minutes passed.
Standing next to the Patient, I pondered. The Patient wasn’t old enough for cataracts or glaucoma, and no such signs were visible in their eyes. It seemed more likely an issue with the retina or optic nerve.
Given the lack of excessive urination, diabetes seemed less probable. If kidney damage from diabetes had occurred, excessive urination would normally accompany it.
Judging by pupil reflexes, there didn’t appear to be any central nervous system issues either. Lucky for the Patient, neither diabetes nor brain-related problems seemed to be the culprit.
Eventually, the Patient brought a sample of urine.
Smelling it revealed no distinct sweetness, which would’ve indicated sugar. Though, to be absolutely certain, I’d have to taste it… but no, I wasn’t going *that* far for this one. Let them live with one eye closed; it’ll suffice.
Partially joking, of course. Based on all available evidence, diabetes appeared unlikely in this case.
Even if it were diabetic retinopathy, treatment options are limited anyway—typically involving laser therapy, which isn’t feasible here.
If it’s not diabetes, what else could it be?
Even if I can’t fully cure the Patient, I should at least determine the cause of their symptoms.
“Patient, would you mind trying this?”
“What now?”
“Press firmly on your eyeball with your finger until you feel it being pressed properly.”
“And what will that do?”
Assuming acute retinal artery occlusion due to a blood clot, applying pressure through proper ocular massage could alter intraocular pressure, potentially dislodging the clot and restoring vision.
“It might help you see again.”
“I already rubbed my eyes a bit.”
“You need to press the actual eyeball, not just the eyelid.”
The Patient followed my instructions.
“Does anything feel different?”
“Oh!”
The Patient squinted their left eye tightly.
Did it work?
“Well, it seems slightly better than before. I can start distinguishing light and dark.”
“Good.”
Summarizing all the information so far:
Based on urine output, it’s not diabetes. Reflex tests indicate no central nervous system issues. Examining inside the eye shows no cataracts or lens/vitreous problems.
What remains is the most likely possibility.
Acute retinal artery occlusion caused by an arterial blood clot blocking blood flow to the retina. A small blood clot is lodged behind the eye, obstructing the retinal artery. Treatment needs consideration.
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So, how do we treat retinal artery occlusion? Ophthalmic surgery requires such precise equipment that it’s out of the question here, but there are other approaches worth trying.
Prescribing an anticoagulant is one option, though even anticoagulants can’t guarantee they’ll dissolve already established clots.
rtPA.
Recombinant tissue plasminogen activator can dissolve clots in stroke patients, but using it here seems unlikely to help. It must be administered within 3 hours, and this Patient has been symptomatic for nearly a day.
It’s unclear if this situation parallels stroke, but things don’t look promising.
Another option…
A needle. Inserting a needle into the eyeball to reduce intraocular pressure could allow the artery to expand, letting the clot pass. It’s risky, but worth considering.
I sighed.
Between the urine test earlier and now needing to pierce their eye with a needle, I keep putting this Patient through unnecessary stress. How will they react when I tell them their eye needs stabbing? Naturally, they’ll panic.
“Patient, I’ve found the problem.”
“What is it?”
“The blood vessels in the retina at the back of your eye are blocked, cutting off blood flow. We can attempt treatment.”
“Phew, that’s a relief. What’s the treatment?”
“We’ll insert a needle into your eye.”
“Is that… even possible?”
Surprisingly,
Yes.
Newton famously jabbed needles into his own eyes multiple times, recording the results as part of experiments on light and color.
As mentioned before, Newton wasn’t entirely sane—possibly due to exposure to toxic substances during alchemy experiments damaging his brain, or maybe he was just eccentric.
Anyway, Newton isn’t relevant right now.
After removing a small amount of fluid from the eye with a syringe to lower intraocular pressure, we’ll check if the clot moves. If not, we’ll try anticoagulants.
“We’ll remove some fluid from inside your eye to reduce pressure, allowing the artery to expand and the clot to move.”
“So, there’s no alternative?”
“Well, this seems like the best option to me. Medication could also work, but it’s not guaranteed.”
“What if the eye moves while inserting the needle?”
“We have anesthesia.”
“Will it hurt?”
I nodded.
Though terrifying, inserting a needle into the eye won’t necessarily be painful.
It’s no different from injections elsewhere after numbing. Just remember never to rub your eyes afterward.
Minor detail.
“It shouldn’t hurt.”
“Alright…”
“In that case, let’s begin.”
The Patient exhaled deeply, reluctantly nodding. I pulled out the anesthetic from my pocket—it won’t take long, and its effects will be immediate.
They didn’t fully trust me, but they complied.
“Stay still.”
I dropped the anesthetic eye drops onto the Patient’s eye. They blinked repeatedly—the sensation of the anesthetic entering the eye can feel strange.
Since facial cavities are interconnected, the anesthetic might also reach the nose, though it’s harmless albeit uncomfortable.
“Istina, come help hold the Patient’s head steady.”
We must ensure precision—only the sclera (white part) should be pierced. Accidentally hitting the pupil or iris could lead to blindness. Absolutely no movement allowed. We laid the Patient down on the clinic bed.
Three hands steadied the Patient’s head.
“Patient, use your hands to hold your head too.”
“Ah, okay.”
Five hands now held the Patient’s head firmly in place.
I carefully picked up the needle.
“Absolutely no movement.”
The needle approached the Patient’s eyeball. The anesthetic seemed effective—no pupil reflex or movement detected.
“Have you done this before?”
“Don’t talk.”
Actually, I haven’t done this much.
Even in emergency rooms, eye-related cases are typically referred directly to ophthalmologists. At most, I might assist with cleaning.
Elbow on the bed to minimize movement, I carefully inserted the needle into the Patient’s eyeball. Transparent fluid emerged.
Then I withdrew the needle.
“All done. You’ll stay in the hospital for observation for a day. Any changes in your vision? Is it improving?”
“It seems a little clearer.”
“Can you see, or not?”
I retrieved a patch from the ward cabinet and handed it to the Patient, who quietly applied it over the recently stabbed eye.
“Wear the patch for a few days to avoid straining your eye. Try not to remove it unless necessary.”
“Okay.”
“Wasn’t it too painful?”
“It hurt.”
I briefly considered this. Of course, inserting a needle into the eye couldn’t be completely painless, but I assumed it was nothing serious.
“In any case, inform us if anything changes. And absolutely do not rub your eye.”
The Patient nodded.
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It’s fortunate that some vision recovery occurred. Whether full restoration happens remains uncertain. Istina and I left the ward.
Istina tilted her head curiously.
“So, we still don’t know exactly what caused the acute partial blindness in this Patient? All we did was alleviate symptoms by sticking a needle in the eye?”
“That’s right.”
“Should we figure out the exact disease?”
Nothing immediately came to mind. What reason would a seemingly healthy young man have for developing arterial clots?
To be honest,
This Patient was lucky.
While retinal artery occlusion is tragic, if the clot had traveled to the brain, a stroke would’ve occurred instead. The prognosis could’ve been far worse.