Ellerbrock Presents: Grand Rounds Sessions

Wednesday, October 11

GR-01: Ellerbrock Presents: Grand Rounds I [COPE ID: 53605-PS]
1:00 PM - 2:00 PM

An IOP of 8mm Hg Is Good, Right? presented by Erin Draper, OD, FAAO
A 72 year old man with a prior history of stroke presents with 8 mmHg IOP differential.  Further investigation shows blockage of the carotid artery to the ophthalmic artery ipsilateral to the lower IOP eye. Asymmetric IOP is typically associated with glaucoma, with the higher IOP eye of greater concern. This case demonstrates that the lower IOP eye may be of greater interest due to decreased arterial flow and impending ocular ischemic syndrome. Early detection and treatment of significant carotid artery disease can prevent future significant vision loss and cerebral infarcts.
Tattoo Related Panuveitis presented by Carl Jacobsen, OD, FAAO
A 24 year old black male presents to clinic with a red, uncomfortable, light sensitive right eye. Initially thought to be idiopathic, nongranulomatous anterior uveitis, his eye condition is resistant to treatment and eventually involves the fellow eye. Further complicating factors include steroid-induced IOP elevation and panuveitis in the right eye. We will review the differential list for panuveitis, review all labs and ocular data, and discuss the eventual diagnosis of tattoo related panuveitis.
I Can't See, What Could It B? presented by Ashley Maglione, OD
We present a case of a 31-year-old female who exhibited the classic features of a nutritional optic neuropathy along with progressive neurologic symptoms. This case highlights the significant impact this condition can have on a patient's visual function as well as their neurologic status. Furthermore, if places emphasis on primary eye care provider's role in identifying this condition, the appropriate work-up, and treatment.

GR-02: Ellerbrock Presents: Grand Rounds II [COPE ID: 53606-GO]
2:00 PM - 3:00 PM

The Carotid Connection presented by Richard Zimbalist, OD, FAAO
This grand rounds case highlights a 69 year old white male who presented to the clinic for a "pink eye" evaluation and was diagnosed with a dural carotid cavernous fistula(CCF's). Interestingly, the diagnosis was overlooked by primary care, radiology and neuro-ophthalmology prior to his examination with us. This course will discuss the causes, signs and symptoms of CCF's. It will also examine the radiological findings of imaging procedures and the treatment options available for these patients.
Acute Bilateral Blindness: Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy in a Patient with Churg Strauss Syndrome presented by Christopher Diehl, OD, FAAO
Churg-Strauss syndrome (CSS) is a systemic granulomatous necrotizing vasculitis. Ocular involvement is rare, and only 31 examples have been reported. This is a case of two different types of ocular infarction presenting simultaneously in CSS.
A Review of the 2016 Practice Guidelines presented by April Lewis, BS, OD, FAAO
This course presents the case of an 81 year old woman with a five year history of hydroxychloroquine use for the treatment of rheumatoid arthritis. The case reviews the 2016 recommendations on screening for hydroxychloroquine toxicity by presenting the results of her retinal examination, visual field, optical coherence tomography and multifocal electroretinogram. Lastly, it reminds the practitioner to determine the best course of treatment for the patient, considering not only the test results, but also the reliability of the results, as well as the effect of the treatment on the patient as a whole.

Thursday, October 12

GR-03: Ellerbrock Presents: Grand Rounds III [COPE ID: 53607-GO]
1:00 PM - 2:00 PM

A Mutation in the Basement: Case Discussion of Alport's Syndrome presented by Timothy Bossie, OD, FAAO
This case primarily focuses on an 18-year-old male and will partially include his 43-year-old mother, both of whom are diagnosed with a rare hereditary condition called Alport Syndrome. The case presentation will discuss the pathophysiology of the disease along with the unique systemic and ocular manifestations associated with the condition. In addition it will highlight the importance of managing these patients in conjunction with their primary care medical team.
Diagnosis and Surgical Removal of Optic Nerve Sheath Meningioma with Intracranial Involvement presented by Gleb Sukhovoskiy, OD, FAAO
A case of complete monocular vision loss after cataract surgery resulting in a discovery of optic nerve sheath meningioma with intracranial spread dangerously close to the optic chiasm, followed by successful surgical resection.
Advanced Retinoblastoma presented by Jasleen Jhajj, BSc, OD, FAAO
Pediatric leukocoria is an ocular emergency that requires immediate evaluation by an eye care professional. The three most common causes of leukocoria in childhood are cataract, Coat's disease, and retinoblastoma. Retinoblastoma is a vision and life threatening intraocular malignancy that requires immediate intervention. Prompt treatment greatly improves the patient's chance of survival. This case report examines the diagnosis and medical/refractive management of a 3 year old patient with leukocoria.

GR-04: Ellerbrock Presents: Grand Rounds IV [COPE ID: 53608-GO]
2:00 PM - 3:00 PM

Conversion Disorder: Stress So Much You See Double presented by Kimberly Laan, OD, FAAO
Conversion disorder is a somatoform disorder where stress manifests as physical changes, sometimes affecting eyes. Treatment is difficult and may involve psychotherapy. This case describes a female whose ocular symptoms were treated with vision therapy.
Lily and the Big Blur: Selecting the Appropriate Myopia Therapy presented by Sarah Kochik, OD, FAAO
While traditional clinical management of myopia has focused on correcting refractive error, we now have a thorough body of literature supporting the treatment of myopia as a progressive eye disease. Three treatments have proven to be both statistically and clinically significant, and are routinely employed in the Myopia Control Clinic at UC Berkeley (orthokeratology, multifocal soft contact lenses, and low dose atropine). This case series aims to demonstrate some of the less-considered patient characteristics that should go into a myopia treatment plan. Specific lifestyle and baseline characteristics are highlighted with relevant supporting literature reviewed for each patient.
Adolescent Third Nerve Palsy presented by Mark Nakano, OD
An 18 year-old Latino Male High School Student with a chief complaint of pain in or around his left eye. Localizes the pain to be more towards the temporal aspect of his orbit. The first incidence was noticed two (2) months ago and the duration is intermittent in presentation.  The patient awoke two (2) months ago with a droopy left eye and some decrease in his left vision too. Medical history: Patient was diagnosed as pre-diabetic in April 2016. Medications and Allergies: No systemic or topical medications are being taken at this time. No Known Medicinal Allergies. Is this an emergent, urgent or wait and see cases?

Friday, October 13

GR-05: Ellerbrock Presents: Grand Round V [COPE ID: 53609-GO]
2:00 PM - 3:00 PM

Limbal Sytem Cell Deficiency, Treatment and Management presented by Eric Syverson, OD, MHS, FAAO
This case demonstrates the use of a bilateral limbal stem cell transplant for the treatment of total limbal stem cell deficiency or failure, due to a chemical/thermal injury, with a small introduction to keratoprosthesis.
Red Eye With Persistent Inflammation presented by Trenton Cleghern, OD, FAAO
This grand rounds case covers a patient with diffuse anterior non-necrotizing scleritis. The 52 year old African America male presented with a three week history of a red, painful eye OS. He was also experiencing photophobia and described that the pain radiated to the temple area. Examination revealed scleral inflammation worse superior temporal OS. A diagnosis of anterior scleritis was made and the patient was started on oral NSAIDs. He eventually needed oral prednisone which resolved his pain, but left significant scleral inflammation. A referral to rheumatology was made to determine if immunosuppressive therapy was needed.
The Confounding Keratitis presented by Marta Fabrykowski, BA, OD, FAAO
After a nebulous landscaping incident, this avid gardener presented to our clinic with an uncomfortable and blurry right red eye. Treating this patient demanded not only clinical deductive reasoning, but also detailed history-taking and plant life investigation. We review the treatment and management of organic trauma, alkaline and acidic injuries and long term concerns of each.

GR-06: Ellerbrock Presents: Grand Rounds VI [COPE ID: 53610-GO]
3:00 PM - 4:00 PM

Pro Bono Corneal Urgency presented by Mona Fahmy, OD, FAAO
A patient is referred for an "urgent, culture-negative corneal ulcer" not responding to a Prokera lens and fortified antibiotics; the referring doctor would like the patient seen the same day without charge. It turns out he has extreme light sensitivity and pain from a large epithelial defect within band keratopathy. This case reviews management of this case of band keratopathy after previous retinal detachment repair and Proliferative Vitro-Retinopathy. It charts out how clinical features of this condition vary from infectious keratitis, discusses weighing treatment options in an eye with low visual potential and reviews current treatment methodologies.
This is Basic: Management of an Alkali Chemical Burn from Sodium Hydroxide presented by Mark Buboltz, FAAO
Ocular chemical burns are a true ocular emergency. The most severe ocular chemical burns tend to be from alkaline substances, as these can penetrate cell membranes due to their lipophilic properties. Aggressive action must be taken with treatment both acutely and chronically. In this case, a patient was referred to our clinic after being exposed to sodium hydroxide (NaOH) to the left eye two days prior. This case will explore the treatment of management of ocular alkaline burns and notably will highlight the integral role cyropreserved amniotic membranes and autologous serum therapy can play in healing the ocular surface.
Utilization of the EyePrint Prosthetic Following Ruptured Globe Repair presented by Ryan McKinnis, BS, OD, FAAO
This case will illustrate the use of the EyePrist Prosthetic device to restore vision in an adolescent that suffered blunt force trauma which resulted in a ruptured globe. Special attention will be given to the thought process utilized in determining the necessity of the EyePrint Prosthetic as well as the safeguards employed to limit the odds of secondary complications.

Saturday, October 14

GR-07: Ellerbrock Presents: Grand Rounds VII [COPE ID: 53611-GO]
10:00 AM - 11:00 AM

The Dilemma of Bilateral Disc Edema presented by Mahsa Salehi, OD, MLS(ASCP), FAAO
This case documents an asymmetric bilateral diabetic papillopathy. Diabetic papillopathy is a term that is used to characterize a finding of unilateral or bilateral optic disc edema with variable visual loss in a patient with diabetes. Specific criteria for the diagnosis of diabetic papillopathy and a clear differentiation of this entity from nonarteritic anterior ischemic optic neuropathy (NAION) have not been distinctly established. Early identification and adequate treatment is the main challenge in the management of such ophthalmological cases.
Rapid Visual Field Improvement After Surgical Decompression of a Recurrent Pituitary Macroadenoma presented by Naida Jakirlic, OD, FAAO
A 34 year old Hispanic male presents with complaints of acute unilateral vision loss in the right eye. Best corrected VA is finger counting at 1 ft OD and 20/20 OS. A grade 4 RAPD is present in the right eye. Dilated fundus examination reveals complete pallor of the right optic nerve. Visual field studies show severe restriction OD and an early temporal defect OS. Neuroimaging reveals aggressive recurrence of a pituitary macroadenoma, prompting immediate surgical intervention. Two weeks after decompression surgery, there is clear evidence bilateral visual field improvement with slight VA improvement in OD.
Reverse Internuclear Ophthalmoplegia s/p Motor Vehicle Accident presented by Samantha Rosen, OD, FAAO
10 year old male presents to clinic with constant eye crossing status-post a severe motor vehicle accident 2 days prior. Upon examination, extra-ocular muscles demonstrate an abduction palsy of each eye in conjunction with nystagmus of the contralateral eye.

GR-08: Ellerbrock Presents: Grand Rounds VIII [COPE ID: 53612-GO]
11:00 AM - 12:00 PM

Metastatic Cutaneous Squamous Cell Carcinoma to the Parotid Gland and Skull Base Presenting as Facial Nerve Palsy presented by Gurpinderjeet Kaur, BS, OD, FAAO
This course will present a case in grand rounds format of a patient with metastatic squamous cell carcinoma to the parotid gland who presented with a facial nerve palsy. Differential diagnoses of facial nerve palsy will also be discussed; along with a through review of ophthalmic management.
Orbital Metastasis from Prostate Adenocarcinoma presented by Jennifer Brown, OD, FAAO
A case presentation of a patient who presented with metastasis to the orbital apex from prostate adenocarcinoma.
Unilateral Incomplete Sixth Nerve Palsy as a Presenting Sign of Multiple Myeloma presented by Gayle LePosa, OD, FAAO
Grand rounds case presentation of a patient who presented in clinic with a sixth nerve palsy secondary to undiagnosed multiple myeloma. Ocular manifestations of multiple myeloma, sixth nerve palsy differential diagnoses, and management of multiple myeloma are discussed.