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DrDLove, Doctor
Category: Health
Satisfied Customers: 18781
Experience:  Family Physician for 10 years, Hospital Medical Director for 10 years.
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Levi is a 17 year old who was violently abused by his father

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Levi is a 17 year old who was violently abused by his father and step mother.
I'm sorry that there has not yet been an answer to your question.

There are two main findings that warrant discussion. Before discussing the findings, it is helpful to clarify certain abbreviations. OU is an abbreviation for both eyes, while OD is for the right eye and OS is for the left eye. PERRLA is a standard abbreviation to describe the pupils and is a normal finding (PERRLA = pupils are equal, round, and react to light and accommodation).

The first finding to discuss is the note of endothelial changes and possible guttata in the cornea of both eyes The cornea is the clear multilayered tissue that covers the pupil and iris. The endothelial layer is the innermost layer. The findings describe changes that can occur with several diseases or prior injury to the eyes, and in someone with a history of violent abuse, any head trauma that was sustained could cause these findings and would be the primary concern. When the doctor uses the term "possible" in the description, that would mean that the finding is subtle and may not require any intervention beyond monitoring.

The other finding to discuss is the possible pallor of the optic nerve head in both eyes. The optic nerve is the nerve that carries the nerve fibers from the retina and carries the message back to the eye. At the point at which the optic nerve enters the eye the nerve is essentially seen on end, so appears as a circle from which the nerve fibers and blood vessels of the retina branch. Pallor refers to a finding that this site appears to have less color (whiter) than would be expected. Pallor can suggest that the fibers of the optic nerve are not as healthy as normal, although the doctor again uses the term "possible," so the changes are subtle. The request for visual field examination will help to further evaluate whether there has been any vision loss related to this finding and consequently whether there should be any concern.

At this point, the next step is the follow-up examination, as recommended by the eye doctor. It also would be important to avoid any further trauma, and since you refer to the abuse in the past tense, hopefully this is entirely in the past.

If you have any further questions, please let me know.
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Customer: replied 4 years ago.

Again many thanks for your comprehensive analysis. I passed your comments on to his mother but she has some other immediate concerns so I have not heard back. I am grateful you had the understanding to answer my question.

You're welcome.
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