A Grand Rounds Web site by an OD for OD and students!

[Richard_Hom]

Dear Forum,

I'm announcing a new web site of Grand Rounds Education. There are interesting clinical cases, weekly clinical tips, a photographic atlas and an article review. Use this web site also to reach my blog on Hospital - based optometry, the only one of its kind. Find out what a hospital -based practice is like. Click here, or jump to http://www.geocities.com/rchom/

Richard Hom OD FAAO
http://www.geocities.com/rchom/

[POJO]

On the the main page there appears to be a photo of a conjunctival lesion. Look further down.

[Richard_Hom]

Here is the web site for you. Grand Rounds Web Site for the optometric community

[ericlemonster]

Originally Posted by Richard_Hom

Here is the web site for you. Grand Rounds Web Site for the optometric community

Very interesting website. Could you post more pictures? How did you take those pictures?

[Richard_Hom]

Originally Posted by ericlemonster

Very interesting website. Could you post more pictures? How did you take those pictures?

Dear ericlemonster,

Of course, as time goes on. I do have over a thousand. Any particular things you would like to see in the way of photographs?

The anterior segment photos were either taken with just the macro setting of my Coolpix 995 or through the oculars of the Haag Streit or Topcon Slit Lamp. The posterior segment photos were either from an Canon 45NM Non Myd digital or from a hand held film fundus camera. I then scanned the slides into digital forms.

Richard Hom OD FAAO

[Richard_Hom]

What is your guess or opinion on why this patient has little retinopathy? See the photos and case history on my main page. http://www.geocities.com/rchom/

Richard Hom OD FAAO

[Richard_Hom]

A news item about a new eBay scam can be found on my main web page at http://www.geocities.com/rchom/

[Richard_Hom]

See the photo index for a case of mydriatics reducing vision from 20/25 to 20/50 each eye after the instillation of mydriatics. Click here. You may have to page down to see the photos.

Richard Hom OD FAAO

[Richard_Hom]

New images on my site. Click here to visit and look for the "newest images" on the left hand side of the page.

[Richard_Hom]

Now available a Grand Rounds case #91 available on my web site. What would you do? See at http://www.geocities.com/rchom/

Richard Hom OD FAAO

[still_confused]

wow the stuff on that site is intense! not much help for a first year student but hopefully i will learn quickly at school to understand what the heck this site is talking about! thanks for a great reference !

[Richard_Hom]

Originally Posted by still_confused

wow the stuff on that site is intense! not much help for a first year student but hopefully i will learn quickly at school to understand what the heck this site is talking about! thanks for a great reference !

Dear still_confused - Please tell your classmates at your school. I welcome their comments.

[Richard_Hom]

Here is something that you might not often see, jump to my web site for a photo of the "yellow" cornea by clicking here.

[Richard_Hom]

See on my main page, a pupil of an unusual shape and location of a patient who s/p cataract extraction. Click here.and then page down once to the new weekly image for the photo atlas.

[Richard_Hom]

This patient presented from the Emergency Department. The patient was found unconscious 2 days before. Upon awakening, he noticed this strabismus and left side hemiplegia. What do you think happened? What would you do?



Richard_Hom

[Richard_Hom]

Chronology of a Posterior Synechiae. Breaking Synechiae may require the use of Atropine, 1%, once a day.

[Richard_Hom]

1. What do you think you would do? Observe or refer?
2. What do you predict the best vision to be?
3. What do you predict the post-operative vision to be if you were to advise excision?
4. If surgical excision is refused by the patient, how would you manage?

See my web site (click here) for a continuing series of interesting photo images. Feel free to use them in your classes or to share with your optometric colleagues and classmates.

[Richard_Hom]

Something to look forward to in your clinical rotations or residency.

This 59 year old male with questionable compliance preented to the Emergency Department requesting pain medication. He had a 3 day history of pain, redness, blurry vision of the right eye. The patient is a historical POAG which is being managed with nightly Xalatan, each eye for the pst 3 yrs. He was characterized by the Emergency Department staff as having Iritis and under the auspices of the on call ophthalmologist was advised to add Ocufen QID and Prednisolone Acetate oph susp, 1% q 2 hrs till the next morning. The Emergency Room staff assured the ophthalmologist that there was no corneal staining.

Upon presentation to the clinic, I found a 5mm x 3 mm corneal ulcer with distinct corneal hypothesia, The surrounding cornea was edematous with significant WBC reaction practically involving the complete visible cornea. In the anterior chamber there was flare Grade 4, Cells #2, and IOPs of 28. The pupil reacted barely to direct and consensual reflexes. The fellow eye was normal with an IOP of 15. The eye was intensely red. Again, the patient requested a narcotic for pain management. Vision in this eye was 20/200 PHNI.

[Schroder79]

Very good site! Thanks for the help! By the way, are you related to Fraser Horn OD here at Pacific U? Just curious.

[Richard_Hom]

Originally Posted by Schroder79

Very good site! Thanks for the help! By the way, are you related to Fraser Horn OD here at Pacific U? Just curious.

Dear Schroder79,

I'm not related. Please feel free to pass this site URL around to your classmates. In addition, I'm on the Allergan Speaker's Bureau, if you would like me to talk to your class or school.

[Richard_Hom]

Day 1 presentation.

Day 5 presentation after topical and oral medical management

This picture and more available on this web site: http://www.geocities.com/rchom. Tell your classmates about this web site.

[Richard_Hom]

[Richard_Hom]

[Richard_Hom]

Typical staining pattern of a corneal with IOP =55 or higher.

[Richard_Hom]

[Richard_Hom]

See more at http://www.geocities.com/rchom/ or my blog at http://360.yahoo.com/rchom

[Richard_Hom]

See more at http://www.geocities.com/rchom/ or my blog at http://360.yahoo.com/rchom

[Richard_Hom]

This case is highlighted as the "case of the month" on my website. To view the details and to offer your insight visit http://www.geocities.com/rchom/. A hospital optometry blog is also available at http://360.yahoo.com/rchom

[Richard_Hom]

Day 1
Day 7 with medical management.

[Richard_Hom]

Here is hoping that your contact lens fitting do no produce this kind of corneal response. See more at http://www.geocities.com/rchom

[Richard_Hom]

Primary Gaze



Closing the eyes.

See more at http://www.geocities.com/rchom

[drmhyde]

Originally Posted by Richard_Hom

Something to look forward to in your clinical rotations or residency.

This 59 year old male with questionable compliance preented to the Emergency Department requesting pain medication. He had a 3 day history of pain, redness, blurry vision of the right eye. The patient is a historical POAG which is being managed with nightly Xalatan, each eye for the pst 3 yrs. He was characterized by the Emergency Department staff as having Iritis and under the auspices of the on call ophthalmologist was advised to add Ocufen QID and Prednisolone Acetate oph susp, 1% q 2 hrs till the next morning. The Emergency Room staff assured the ophthalmologist that there was no corneal staining.

Upon presentation to the clinic, I found a 5mm x 3 mm corneal ulcer with distinct corneal hypothesia, The surrounding cornea was edematous with significant WBC reaction practically involving the complete visible cornea. In the anterior chamber there was flare Grade 4, Cells #2, and IOPs of 28. The pupil reacted barely to direct and consensual reflexes. The fellow eye was normal with an IOP of 15. The eye was intensely red. Again, the patient requested a narcotic for pain management. Vision in this eye was 20/200 PHNI.

yummy...what did the MD say about the case. (besides...oh S@#*)

[Richard_Hom]

Interestingly the CCT ws 850 in this photo. Patient presented with IOP 70 at the beginning visit. After 48 hours with a host of topical and orals, the IOP dropped to the mid 30's. Etiology secondary to neovascular glaucoma following a vitreous hemorrhage and in the presence of pervasive proliferative diabetic retinopathy and rubeosis irides
See more photos at http://www.geocities.com/rchom/

[Richard_Hom]

I know, this isn't a spectacular case, but it is not uncommon and may be the reason for FBS, persistent redness and eye discomfort.

See more at http://www.geocities.com/rchom/

[Richard_Hom]

[Richard_Hom]

To see more, go to www.geocities.com/rchom/ or to my blog at http://360.yahoo.com/rchom

[Richard_Hom]

Conjunctival foreign body near the point of the pterygium entering the cornea.

[Richard_Hom]

Day 1 first presentation of Iritis



Day 3 - Atropine 1%, Daily

[Richard_Hom]

We sometimes get complaints of watery eyes. In this case, the ectropion could certainly contribute to the complaint. What do you think?

Richard Hom OD FAAO
The Grand Rounds Web Site for ODs - http://www.geocities.com/rchom/

[Richard_Hom]

Richard Hom OD FAAO
http://www.geocities.com/rchom/

[Richard_Hom]

Jump to this URL for a tip on detecting Anterior Chamber Flare: http://www.geocities.com/rchom/

[Richard_Hom]

A discussion of tonometry with either Fluress vs fluorescein strip and anesthetic.

Richard Hom OD FAAO
http://www.geocities.com/rchom/

[Richard_Hom]

Second case in a few months. I didn't know that this problem was as common as I have seen.

See more at http://www.geocities.com/rchom/

[Richard_Hom]

Pretty common, but sometimes missed. This one is pretty obvious. These catarcts are missed mainly because the observer doesnt' focus the slit lamp posteriorly. It also interferes with retinoscopy.

Richard Hom OD FAAO
http://www.geocities.com/rchom/

[Richard_Hom]

This past week was filled with children. I saw this child presenting with this head position. Normal or abnormal?

Richard Hom OD FAAO
http://www.geocities.com/rchom/

[Richard_Hom]

Just by the history what would your differential diagnoses be? By the way, this eye is Counting Fingers (CF or FC) at 1 foot). The eye is red and painful and light sensitive.

Richard Hom OD FAAO
http://wwww.geocities.com/rchom/

[Richard_Hom]

Vitreous strands over the retina. You might even see some small NVD. Hazy view because of a vitreous hemorrhage that is slowly resolving.

Richard Hom OD FAAO
see more at http://www.geocities.com/rchom/

[Richard_Hom]

Over 250/120 and was referred to the ER for hypertensive crisis. He looked a bit ill.

Richard Hom OD FAAO
See more at http://www.geocities.com/rchom/

[Richard_Hom]

Iritis, 2d episode within a year. Charatcteristic mutton fat tending to occupy the lower half of the corneal endothelium.

See more at http://www.geocities.com/rchom/

Richard Hom OD FAAO

[Richard_Hom]

Sometimes, you get a pterygium and you shake your head.