The Eye and I

By Dr. Johan Zwaan

This book is a story book about the eye. After some 60 years in eye research and clinical work in ophthalmology there have been many instances, where I remember patients and their problems, a book I read or a place that I traveled. This book has 30 chapters and the only thing they have in common, other than all having th

• Language: English
• Publisher: Bookside Press
• Release date: May 16, 2023
• ISBN: 9781778830860

Dr. Johan Zwaan

Johan Zwaan was born in Gorinchem, Holland, in 1934. He lived there during the occupation of Holland by the Nazis from age 5 to 10 years. Later he attended the local classical high school Gymnasium Camphusianum, which he completed at the age of 16. He attended medical school at the University of Amsterdam. His studies were interrupted when he was drafted in the Royal Dutch Army in 1954. After his discharge from the Army, he returned to Amsterdam in 1956. In 1960 he received the MD degree and three years later the Ph.D. for research started in medical school. The day after the defense of his thesis he left for the United States for a one-year postdoctoral fellowship in Pediatric Research at Johns Hopkins Medical School. After seven years at the University of Virginia, he became a faculty member at Harvard Medical School. He missed contact with patients and Harvard gave him three years leave, and at age 40 he entered an Ophthalmology training program in Albany, NY. On completion, he returned to Harvard for another 10 years, this time in the Ophthalmology Department. In 1988 he moved to the University of Texas in San Antonio as a Professor of Ophthalmology, Pediatrics, and Cellular and Structural Biology. After 7 years he was invited to join the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. Three years later, in 1998, he returned to San Antonio and entered private practice. He retired in 2017. During his career, he published numerous scientific and clinical papers, book chapters, and a textbook, Decision Making in Ophthalmology (in 2014). After retirement, he took up non-medical writing.

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Copyright © 2023 by Dr. Johan Zwaan

ISBN: 978-1-77883-085-3 (Paperback)

978-1-77883-086-0 (Ebook)

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case brief quotations embodied in critical reviews and other noncommercial uses permitted by copyright law.

The views expressed in this book are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

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Foreword

This is not a clinical collection or a medical textbook.

The chapters have in common that they all have something to do with the eye.

I spent some 15 years, starting during medical school, in eye research and then 45 years as primarily a clinical ophthalmologist. This book is a compilation of patients I remember (names and sometimes circumstances of course have been altered to protect patient privacy) for a variety of reasons. It is a bit of a travelogue, and touches on embryology, genetics, zoology and ancient history. In short, it is an eye storybook. I have tried to make it accessible for non-physicians.

It is illustrated with pen drawings, the best ones by my son Alex, the remainder by me.

I am a computer ignoramus and owe a great deal of thanks to my daughter-in-law, Amanda Zwaan-Lai for making the loose chapters into a book and to my sons Alex and Andrew for aid with computer problems and also for reading the whole manuscript and freely criticizing it.

I thank my wife Karen for her support and for her patience, while I was writing this.

CONTENTS

UNWELCOME LASH GUESTS

THE NUN WHO SAW DOUBLE

I WANT LIGHT

DEATH OF A DWARF

THE GIRL WHO SAW BLURRY

THE GIRL AND THE CAT

A GAGGLE OF PINK EYES

A BLIND KID

MY FIRST OPERATION

DOUBLE TROUBLE

FRENCH DROOPY EYELIDS

A HALFHEAD HEADACHE

ROYAL TRACHOMA

SPANISH FLY IN THE EYE

AN OLD PITCHFORK INJURY

STEMCELLS?

CYCLOPS

A WINKING BABY

BAD BEHAVIOR OR BAD VISION?

WHITE RICE, GREEN TEA

ONDINE’S CURSE

BROKEN EYES

FROZEN EYES

THIRD EYE

CROSS-EYES

POTPOURRI

MICROPREEMIE

A NASTY PILL

VISUAL HALLUCINATIONS

WHY DID I MOVE TO THE US?

CHAPTER ONE

UNWELCOME LASH GUESTS

In 1983 President Ronald Reagan used the excuse that American students attending the St. George Medical School on Grenada were in imminent danger and needed to be rescued from the communists, taking over the government of the island. With the help of Cuban engineers, Grenadian workers were building a giant airfield, considered a possible threat for the US. The island of Grenada was invaded. It was not known to the military there were two campuses with student housing. One was liberated very early, the other only several hours later, increasing the risk for hostage taking. The other problem was the bombing of an institution for the insane, which left a number of the patients to freely roam around. It appears that US Intelligence left something to be desired.

After the fighting was over, USAID swung into action and organized to restore essential services to the people of Grenada. Among these was the reopening of the Eye Clinic at the hospital, which had been staffed by Cuban physicians and now they were gone.

Volunteer ophthalmologists were asked to re establish the Eye Clinic of the St. George Hospital and I was the second physician taking over the clinic. I did not have to think about it: I had visited the island several times before as a guest lecturer giving Embryology lectures at the Medical School and I had really enjoyed it. There is an old Chinese curse: May you live in interesting times and my travels to Grenada were indeed interesting. I had to fly into Barbados to catch a small commuter type plane flying from there to Grenada. The passengers were loaded and then we sat and sat and sat on the tarmac in the hot sun waiting for departure. No engine was running and the only cooling, which was not very effective, came from the open door. When I heard loud hammering going on, I looked out the door and there was a man, later turning out to be the pilot, hammering away at one of the wheels of the landing gear, not exactly inspiring much confidence in the airworthiness of the plane. But finally, he appeared to be satisfied and with the hammer still in hand he climbed on board, sat down in the cockpit, started the plane and we were on our way. After what felt like a long hour we reached Grenada, when it was already getting dark. The old Pearls airport, where we landed was a small grass field, caught between the ocean and the mountain, with no landing lights, and if we had been 10 minutes later the landing would have been aborted. The AK-47 touting teenage soldiers guarding the airfield on previous occasions were gone.

There was no one there, except for some waiting taxi drivers. I asked them whether anybody knew where a house, formerly occupied by Cuban embassy personnel and now assigned to USAID, was located and between them they figured it out after much discussion. I climbed aboard the first car in line and we departed for the other side of the island, driving on the left (Grenada used to be British) and narrowly avoiding numerous goats and dogs on the roads across the mountains to the other side of the island. The driver took me to a house in a very nice-looking street; it could have been located in an American suburb.

A wrought iron fence ran around it and the gate was locked. There was a small car parked next to the house, ready for my use, as had been promised. The house appeared to be unoccupied. There was not a soul in sight, so I climbed over the fence. The front of the house seemed entirely empty when I looked through the windows, but many forms and other papers were lying scattered on the floor. Suddenly a side door flew open and a man in his underwear jumped out, swinging a pistol in his hand around in the air. He threatened that he had all the right to shoot me right then and there and yelled that I had violated Cuban territory by climbing over the fence and entering the grounds of the Embassy. While he was ranting and raving, I slowly retreated to the fence, all the time keeping an eye on him, and jumped back over it as soon as I could.

The cab driver was more than ready to take off and before I even sat down, he hit the gas pedal and got us out of there. I told him to take me to the St. George Hospital and there it became clear where the USAID house was located, on a hill above the new Point Salines airport partially built by the Cubans. An aide took me to the house. There still were plenty of signs around the house of the recent fighting, such as spent cartridges and empty ration cartons.

The next morning, I started at the Eye Clinic of the St. George Hospital. Many of the instruments were hand-me-downs from the USA and many were in deplorable state, such as forceps with all the teeth broken off. The eye problems seen were not all that different from those in an average USA clinic, except that there was a much larger prevalence of glaucoma sufferers.

One morning the matron (nursing director) of the hospital came to the clinic with a complaint of an itchy pink eye. Her vision was 20/20 and there was no tearing or discharge, but the skin of the eyelids looked slightly erythematous and a bit scaly. The conjunctiva was minimally injected. The remainder of the exam was entirely normal. I thought that the matron probably had an allergic reaction or possibly a viral infection. I placed her in the slit lamp and focused.

And there were the culprits: very small, pearly ovals glued to the shafts of the lashes, looking like mini olives stuck on a toothpick. Others seemed to be small crustaceans, crawling at leisure along the lashes.. The crustaceans were lice and the olives their eggs or nits. The good matron had Pthirus pubis, better known as pubic lice or the crabs. When I told her, her face turned red and she looked rather embarrassed. I leave it to your imagination to figure out how the crab lice got from her pubic area to the lashes.

Fig. 1-1. Drawing of a pubic or crab louse. This is a species, different from the head louse. To me it looked more portly than body lice, with relatively large claws to hold on to the lashes.

Fig. 1-2. A nit (egg of the crab louse) glued to the eyelashes.

Lice infestation becomes more prominent when poverty is worse than usual and hygienic measures leave a lot to be desired. In the middle of WWII my mother used to check the hair of my brothers and me every night, with a special fine-toothed comb, for good reason. Classrooms looked very different in those days. Our desks were arranged in neat rows; we wrote with pens that had to be dipped in a little ink well built into the desk. The girl in the desk in front of me had beautiful blond long hair, but she also had loads of head lice. When they fell on my desk, which happened regularly, I would pick them up with my pen and drown them in the inkwell.

Fig. 1-3. Head louse (left) and body louse (right), both subspecies of Pediculus humanus and virtually indistinguishable.

Lice have been with mankind for several million years. Many birds, pets and other mammals have lice, unique for each species. The closest relative of Pediculus humanus, the human head louse and body louse, is the chimpanzee louse. The divergence of these two types of lice may have occurred 4.1 to 5.5 million years ago. The human lice split into two separate clades 1.8 million years ago. There is a worldwide clade, A, which includes both body and head lice, and a B clade, the New World clade, which consists only of head lice. Head lice, as the name indicates, live and breed on the scalp and the body lice in clothing. Both are obligate parasites and they feed on blood from the skin. Body lice may have diverged from head lice around 100,000 years ago, when humans began to wear clothing. This transition may have happened more than once, because not all human tribes developed clothing at the same time. While there are minor differences between the two groups, they are still considered the same species, Pediculus humanus.

Crab or pubic lice are a different species, Pthirus pubis, that may have been derived from the gorilla louse, as much as