Your Cornea Reminds Me of this trip I took to the Great Lakes...

Guest Post:

Age/Race/Gender: 57 Hispanic Male

CC: 57 yo male presents for f/u recurrent HSK OD.

HPI: 1 active presentation OD, 1 recurrence w/in 1 year OD. Patient denies redness, photophobia, or change in vision. NO flashes, floaters, or ocular pain. Complains of itching after instillation of glc meds.

POHx:

1. Recurrent HSV keratitis OD

2. h/o occludable angles OU, s/p LPI OU(revision OD 12/15/10, revision OS   7/17/10)

3. Cataracts OU, non-visually significant

4. glaucoma suspect OU

-Gonioscopy 7/2010:

OD: anterior TM inferiorly, narrow occludable

OS: pigmented TM inferiorly, mildly narrow

-HVF 24-2 OU 4/2010:

OD: unreliable, no real deficits seen

OS: unreliable, some small central defects noted

-RNFL 8/30/2010:

OD: superior and inferior thinning

OS: green 360, no thinning

Ocular Medications:

Brimonidine 1 gtt TID OU

trusopt 1 gtt BID OU, using qd OU

Prednisolone qd od

Acyclovir 400mg BID PO, taking 200mg BID

PMHx:

1. non-DM 07/13/2010 A1C GLYCOHEMOGLOBIN 5.70

Entering Visual Acuity cc

OD: +1.25 +0.75 x015 20/25-1

OS: +2.25 +0.75 x170 20/20

MRx:

OD: +1.75 +0.50 x005 20/25-1

OS: +2.00 +0.75 x170 20/20

pupils: 2.5 mmL, 3.5 mmD, round and equally reactive 1+, no APD OU

Ocular Tension - TAP

R 16

L 18

slit lamp:

lids: clear OU

conj: clear OU

cornea: OD: diffuse stromal haze c band forming temporally, no active inflammation or dendrite

OS: clear

A/C: deep and quiet OU

iris:

OD: LPI patent 9 o'clock

OS: LPI NOT patent at 3 o'clock

lens: 1+ NS OU

ant. vit: syneresis OU

DFE: 1 gtt 2.5% phenylephrine, 1 gtt 1.0% tropicamide OU; AUG 01, 2011 12:50

vitreous: syneresis OU

C/D:

OD: 0.55/035

OS: 0.4/0.4

nerve: pink, distinct margins OU

macula: clear, flat OU

vessels: healthy, 2/3 OU

periphery: no breaks, holes, tears 360 OU

*photos below of previously active lesion*

Unable to do Near Work

Guest Post:

Age/Race/Gender: 46 Black Male

CC: 46 yo BM c h/o end stage POAG OU presents for initial low vision evaluation; lost to f/u for > 1 yr.

HPI: Patient describes trouble focusing between near and distance VA c current specs. Typically removes specs for near work. Complains of trouble with glare and photophobia and decreased vision outdoors. Depends on cane for mobility outdoors, especially in the afternoon. No flashes, floaters, or ocular pain.

POHx:

1. End stage glaucoma s/p TRAB/MMC OU and iridectomy OD/LPI OS - stable IOPs OU s/p April 2010 TRAB surg

2. Superior operculated retinal holes OD - pt with stable h/o photopsia since 1983

PMHx:

1. GERD

2. tobacco use

SHx: attends associate degree program in electrical engineering; extensive work on circuit boards. School has already provided a mounted, lighted magnifier for desk work.

Entering Visual Acuity cc

OD: -3.25 + 0.50 x020 20/25-2

OS: -3.25 + 1.00 x165 20/20-1

MRx:

OD: -3.00 +0.75 x030 20/25+1

OS: -3.25 +0.50 x135 20/20

Near VA c +1.00 add 20/20 OU

pupils: surgical OD, OS round and reactive 1+, no APD OU by reverse

CVF: severly restricted OD, OS (review of HVF 24-2 2/4/2010) Visual Field restricted to approximately 10 degrees horizontal by 6 degrees vertical in the right eye, 15-20 degrees horizontal by 6 degrees veritcal in the left eye.

EOM: full range of motion OU

Visual goals:

1. Near tasks, reading, studying: circuit boards, textbooks

2. Intermediate goals, computer text and computer glare

3. Problems with indoor/outdoor glare

4. Problems with contrast/lighting outdoors

Device Evaluation:

1. 3X Eschenbach pocket magnifier with LED light over OS with VA: 20/20

2. NoIR filters, pt prefers: light grey

3. Cocoon polarized filters, pt prefers: large, grey

Ocular Tension - TAP @ 8:38 am.

OD: 10

OS: 9

Slit Lamp:

lids: mild MGD OU

conj: ST elevated avascular bleb OU

cornea: scattered PEE OU, +NaFl staining between 3-9 o'clock OU.

tears: TBUT < 3-4 sec OU

A/C: deep and quiet OU

iris: superior iridectomy OD, large superior iridotomy OS

lens: 1+ NS OU

ant. vit: clear OU

Undilated c 90D Volk:

C/D: 0.95 OD, OS

nerve: pale, distinct margins OU

macula: clear, flat OU, +FR OU

vessels: healthy, 2/3 OU

Assessment and Plan in the comments.