The lasting lessons of a medical emergency
Eight years later, I sometimes forget which eye it was. Despite a few false alarms, I’ve never had a recurrence – but I still remember the fear and pain and outright misery of an ordeal that lasted little more than a week. It’s incredibly easy to take your eyes for granted, until a doctor in Central America is scraping off the outer layer of your diseased left cornea to save your sight.
This is where my story diverges from that of many other patients battling eye pain, however. A husband-and-wife ophthalmology team in Guatemala clearly saw something wrong – unlike the ‘invisible’ condition of chronic eye pain, my symptoms matched the clinical signs of trouble. And although I was miserable, my pain persisted for days, not months or years.
Looking back, this is what strikes me the most: an eye in distress can rule your life.
Saturday: Disaster can strike anywhere
Fuentes Georginas is a lovely complex of volcano-fed, sulphur-scented hot springs, with a spectacular backdrop of ferns and palms that climb a steep hillside near the Mayan village of Zunil in western Guatemala. My partner and I have come here on the fourth day of a planned three-month tour through Central and South America in the spring of 2007; we have set out to explore the countryside before beginning a week of Spanish lessons at a language school in the colonial town of Antigua. At one point, while playing volleyball with two local kids in the main pool, I splash into the water and foolishly keep my eyes open as I go under.
Sunday: Eye diseases can progress incredibly rapidly
By the afternoon, my left eyelid is swollen and the pain has begun – like an eyelash on the cornea that I can’t remove. I try a simple medication at a local pharmacy, but it doesn’t help.
Monday: Visible symptoms will elicit sympathy from nearly everyone
Back in Antigua, my Spanish teacher for the week, Elena*, frets over my increasingly irritated eye, which is fluttering and producing a continuous stream of tears in a furious attempt to flush out the source of the pain. She tells me, in Spanish, about the terrible year she is having. “I can see that you are crying, but alas, the tears are not for me,” she says. We both laugh.
Our next lesson is about the pharmacy, where she insists that I go for new eye drops, or gotas. That night, we linger at the dining room table and talk with our host mama, Silvia*, after a delicious home-cooked meal. I decide not to study because my vision has begun to blur. That night, I can’t sleep at all.
Tuesday: You seldom think about your eyesight – until you can no longer see
Now Silvia is worried too, and she gives us the name of the eye doctor treating her mother. In the morning, I conjugate Spanish verbs while the language school’s administrator sets up an eye appointment with Dalia González de Golcher at Centro Visual G&G. The reality hits home when the ophthalmologist asks me to read an eye chart. With my right eye closed, I’m shocked to discover that I can barely read the top line with my left. Then she inspects my cornea, and the lesions give it away: something is attacking it.
But what? A bad viral infection, she hypothesises. She sets up a follow-up visit with her husband, who specialises in these kinds of conditions. I have been using eye drops with steroids, and she tells me to stop taking them immediately (some steroids, preservatives and other eye drop components, as doctors are learning, can actually make the symptoms worse). Instead, she prescribes an anti-inflammatory drug, lubricating drops, and oral and cream versions of the antiviral acyclovir. Although I’m frightened, the diagnosis at least provides a plan of action to fight the attack.
Wednesday: Deteriorating eyes often require a change of plan
Elena and I scrap our formal lessons and instead discuss politics, history and her personal woes. We take a field trip to a nearby town named San Antonio Aguas Calientes and shop for textiles. This is all fine with me because I can no longer read.
Thursday: Medical procedures in foreign countries are an easy way to alarm loved ones
At my follow-up eye exam, ophthalmologist José Golcher tentatively diagnoses me with herpes simplex keratitis (caused by the same virus that can prompt periodic cold sores) and decides to remove my diseased outer epithelial layer. He anaesthetises my eye, clamps it open and gently scrapes away the corneal tissue with a sterile cotton swab. As I later learn, the procedure is called epithelial debridement. He then fits me with a hard contact lens, which will act like a bandage while the epithelium grows back, and prescribes some antibiotics.
A few hours later, the tears begin, and I can’t stop crying for the rest of the day. Both my eyelid and my eyebrow are swollen and I look like I’ve been hit. My partner grows so alarmed that we start discussing whether to cut our trip short and return to New York.
Friday: Even a mild improvement is often reason to celebrate
My eye feels slightly better but is incredibly puffy and sensitive to light. Everyone else in Antigua is thrilled and nervous because of the roar of American fighter jets flying low overhead: a scouting mission in advance of a pending visit by President George W Bush. Silvia tells us later she thought it was the eruption of a nearby volcano. My eye continues to improve throughout the day, and we decide to celebrate the end of our Spanish classes. By the end of the night, we’ve stopped talking about returning to New York.
Saturday, Sunday and Monday: Life can return quickly to normal in the absence of pain
My eye feels better every day, until I have nearly forgotten about it as I soak up the beauty of Guatemala’s volcanic Lake Atitlán. Life is good.
Tuesday: Given a fighting chance, the body has a remarkable ability to heal
In Antigua at my final check-up, Golcher tells me the epithelium has completely healed, with no signs of infection. I receive another medication: gotas to strengthen the tissue. Nine days after my symptoms began, they have ended. After three doctor visits, six types of medicine and a shockingly small bill of US$166, I receive a clean bill of health.
2015: We’re still learning about the nasty things that can attack our eyes
As it turns out, the menagerie of tiny beasts that can invade our eyes includes a startlingly large group of bacteria, viruses, fungi, amoebae and parasites. In 2012, researchers in Taiwan documented nine cases of an emerging eye disease known as microsporidial keratitis. All of the patients contracted it after soaking in sulphur hot springs. When I chanced upon the study earlier this year, I was instantly transfixed. I emailed one of the authors, Pei-Yu Lin, and described my similar exposure and symptoms. Could microsporidial keratitis have been the true culprit?
Although the symptoms and positive response to the corneal scraping procedure fit with a microsporidia infection, he replied, other disease agents could behave similarly. Even so, Lin did some checking on his own and found a separate study that found microsporidia contamination of rural drinking water around Guatemala City.
At the close of his letter, in an almost offhand way, Lin imparted one last, chilling lesson: in the absence of early intervention, eye conditions can prove disastrous. “This cornea infection is easy to treat with epithelial debridement if only the parasites are confined in the superficial epithelium,” he wrote. “However, corneal transplantation is usually necessary if the parasites penetrate into a deeper layer.”
It never came to that, thanks to the kindness and generosity of multiple Guatemalans who barely knew me, and the prompt and careful attention of two discerning ophthalmologists. Sadly, not everyone is so lucky.
Some names, marked with a *, have been changed.
Read our related article on 23 facts about eyes and what can go wrong with them.