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Richard_Hom

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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/
Members don't see this ad.
 
On the the main page there appears to be a photo of a conjunctival lesion. Look further down.
 
Members don't see this ad :)
ericlemonster said:
Very interesting website. Could you post more pictures? How did you take those pictures?
Click to expand...

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

Dear still_confused - Please tell your classmates at your school. I welcome their comments.
 
Here is something that you might not often see, jump to my web site for a photo of the "yellow" cornea by clicking here.
 
Members don't see this ad :)
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.
 
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?

Strabismus_NOS_03.jpg


Richard_Hom
 
AtropineAndIritis2.jpg


Chronology of a Posterior Synechiae. Breaking Synechiae may require the use of Atropine, 1%, once a day.
 
Pterygium_01.jpg


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.
 
Corneal_Ulcer_14.jpg

Corneal_Ulcer_15.jpg


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.
 
Very good site! Thanks for the help! By the way, are you related to Fraser Horn OD here at Pacific U? Just curious.
 
Schroder79 said:
Very good site! Thanks for the help! By the way, are you related to Fraser Horn OD here at Pacific U? Just curious.
Click to expand...

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.
 
Day 1 presentation.
RashPuffyLid.jpg

Day 5 presentation after topical and oral medical management
RashPuffyLid_02.jpg

This picture and more available on this web site: http://www.geocities.com/rchom. Tell your classmates about this web site.
 
Corneal_Staining_HighIOP_01.jpg


Typical staining pattern of a corneal with IOP =55 or higher.
 
PainfulEye_01.jpg
Day 1
PainfulEye_02.jpg
Day 7 with medical management.
 
Richard_Hom said:
Corneal_Ulcer_14.jpg

Corneal_Ulcer_15.jpg


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.
Click to expand...

yummy...what did the MD say about the case. (besides...oh S@#*)
 
IOP70_01.jpg

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/
 
Conjunctival_FB2.jpg


Conjunctival foreign body near the point of the pterygium entering the cornea.
 
Iritis_03.jpg


Day 1 first presentation of Iritis

Iritis_04.jpg


Day 3 - Atropine 1%, Daily
 
WateryEyes_01.jpg


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/
 
Cataract_09.jpg


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/
 
Cornea_25.jpg

Cornea_26.jpg


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/
 
NPDR_10.jpg


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/
 
Cornea_27.jpg


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
 
Pterygium_Advanced_02.jpg


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