Periorbital trauma from pit bull terrier attacks.

PURPOSE: To report the nature of periorbital trauma after pit bull attacks. While these attacks have been well-characterized in the popular media, no case series has documented the ophthalmic manifestations of this trauma. METHODS: We retrospectively reviewed all cases of pit bull terrier attacks that presented to the oculoplastic and orbital surgery service at Albany Medical Center between 2008 and 2011. The age, gender, extent of the injuries, care provided, follow up interval, and complication rate were evaluated for each patient. RESULTS: Seven patients were identified, with a mean age of 17.2 years. Six of the seven patients were in the pediatric age group. All patients suffered eyelid lacerations, and only one patient had additional injuries. Four patients (57.2%) suffered a canalicular laceration. Despite the lack of post-operative oral antibiotic use, no patient developed a wound infection. CONCLUSIONS: In the ophthalmic setting, pit bull terrier attacks most frequently involve children and result in eyelid lacerations. Canalicular injuries are common after these attacks.

Orbital cellulitis with subperiosteal abscess: demographics and management outcomes.

PURPOSE: Infectious orbital cellulitis represents a serious threat to vision and, if untreated, poses significant morbidity risk. In this study, the authors attempt to further characterize the features of orbital cellulitis with subperiosteal abscess (SPA) and determine outcomes based on the type of surgical intervention employed. METHODS: Data were obtained by retrospective chart review of all inpatient admissions for orbital inflammation/cellulitis from Sept 2005 to April 2010. Charts were reviewed for demographic information, radiographic and clinic evidence of orbital cellulitis, presence of SPA (defined by radiographic criteria), interventions taken (surgical and nonsurgical), presence of concurrent sinusitis, types of microbes present, and duration of hospital admission. Statistical analysis was performed using chi-square tests. RESULTS: A total of 97 patients were admitted with a diagnosis of orbital inflammation/cellulitis, of whom 49 patients had clinical and/or radiographic evidence of orbital cellulitis. Twenty-four patients had radiographic evidence of SPA. All patients with SPA had concurrent sinusitis, and 16 patients underwent initial surgical intervention. Nine patients had external transcaruncular/transcutaneous SPA drainage only, 6 had combined SPA and sinus drainage, and one had sinus drainage alone. Of those that underwent SPA-only drainage, 5 had SPA reaccumulation, while no reaccumulation occurred with combined SPA and sinus drainage. No reaccumulation occurred if the SPA was less than 2 cm in its greatest diameter. CONCLUSION: In this study, for those abscesses larger than 2 cm, combined sinus and SPA drainage was associated with improved treatment outcome, demonstrated by absence of abscess reaccumulation and shorter hospital stay. SPA-only drainage was more frequently associated with SPA reaccumulation.

Primary orbital manifestation of Hodgkin lymphoma in a 3-year-old child.

Hodgkin lymphoma is exceedingly rare in children, as is primary orbital manifestation of systemic Hodgkin lymphoma in any age category. The authors describe the clinicopathologic manifestations of a rare case of systemic Hodgkin lymphoma with primary orbital manifestation in a 3-year-old boy with histologically proven Hodgkin lymphoma with mixed cellularity. After an incisional biopsy and tumor debulking, followed by systemic workup, the diagnosis of stage IVA Hodgkin lymphoma was made. He underwent treatment with 4 cycles of adriamycin, bleomycin, vincristine, etopiside, prednisone, and cyclophosphamide, followed by involved field radiation. He has been followed at regular intervals for 6 years. Scans have shown resolution at all sites, and blood counts have remained normal. To the best of the authors' knowledge, this is the youngest patient with primary orbital manifestation of Hodgkin lymphoma reported in the English literature.

Fellowship selection criteria in ophthalmic plastic and reconstructive surgery.

INTRODUCTION: Competition for subspecialty fellowship positions in ophthalmology continues to grow, and there is increasing interest regarding the factors considered important in fellowship selection. While a previous report evaluated the characteristics and criteria used by ophthalmology subspecialty program directors to select fellows in retina, cornea/external disease, and glaucoma fellowship programs, to the authors' knowledge no such study has evaluated Ophthalmic Plastic and Reconstructive Surgery (OPRS) fellowships. METHODS: The authors surveyed the program directors of all American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)-sponsored fellowships in the United States and Canada. The survey contained 16 criteria related to the selection of fellows. A Likert scale ranging from 1 (not important) to 9 (very important) was used for prioritizing the criteria. Opportunity was afforded for comment on other measures, and program directors were also asked to select their most important factor used for fellow selection. RESULTS: The return rate of the completed surveys was 35 of 48 (73%). The 3 criteria with the highest mean Likert scale scores were the interview process (8.7), the ability to work and communicate with others (8.5), and letters of recommendation from subspecialty faculty (7.8). Likewise, the criterion selected as the single most important by respondents was the interview (58%), the ability to work and communicate with others (15%), and letters of recommendation from subspecialty faculty (15%). CONCLUSIONS: The authors' findings demonstrate that OPRS program directors place greater emphasis on qualities assessed during the interview, letters of recommendation from same specialty faculty, and the ability of the applicant to work and communicate with others. While not identical, our findings were similar to those noted for other ophthalmology subspecialties. The results support the suggestion that residents interested in fellowship training may benefit from faculty mentors in their area of interest early in their training. With the high interest in OPRS and other ophthalmology subspecialty fellowship training, the authors hope that this report will be useful to applicants, residency programs, and fellowship directors.

Ophthalmic plastic and reconstructive surgery (OPRS) fellowships: assessment and comparative data from the 2009 Specialties Matching Service.

INTRODUCTION: Among specialty fellowships available in the United States, matching in ophthalmic plastic and reconstructive surgery (OPRS) is widely thought of as an exceptionally competitive process. There are articles discussing fellowship selection and competition in other fields of medicine; however, little information is available in the peer review literature regarding the process for OPRS. METHODS: In this study, the authors evaluate match statistics, available from the National Resident Matching Program, for the class of fellows with appointments for training beginning in 2009. These statistics are compared with the 36 other advanced specialty training programs, in a wide range of medical and surgical fields, also participating in the Specialties Matching Service. RESULTS: OPRS fellowships are 1 of only 5 specialties that filled all available positions in the 2009 match and 1 of only 3 programs to fill all available positions in each of the past 4 years. In addition, 88.9% of positions were filled by U.S. graduates, the highest among all programs (range = 5.0%-88.9%, mean = 54.8%). Of those applicants who matched, OPRS fellowships had the lowest percentage of applicants, 22.9%, match at their first choice program among single specialty matches (range = 22.9%-75.0%). A total of 48.6% of OPRS applicants did not match-the highest among single specialty matches and the second highest among all programs, including combined specialty matches (range = 4.3%-53.5%). CONCLUSIONS: OPRS fellowships are among the most selective advanced specialty positions available in the United States. Among all specialty programs participating in the Specialties Matching Service, OPRS fellowships have nearly the highest unmatched applicant rate, highest U.S. graduate fill rate, and lowest first-choice match rate. These statistics indicate that the applicant pool is competitive and that both applicants and program directors (preceptors) are selective with their rankings. The authors believe these findings will be of interest to residents interested in further training in OPRS and to program directors, chairs, and others involved in the specialist educational process.

Comparison of pain scores with 30-gauge and 32-gauge needles for periocular botulinum toxin type a injections.

PURPOSE: To determine whether a 32-gauge needle can reduce the pain associated with periocular injections of botulinum toxin type A compared with 30-gauge needles. METHODS: In this prospective, randomized, masked study, 30 patients received bilateral periocular injections of botulinum toxin type A for benign essential blepharospasm. For each patient, a 30-gauge needle was used on one side of the face, and a 32-gauge needle was used on the other side. Equal number of injections and equal amounts of botulinum toxin type A at each injection site were administered on each side of the face. Patients were then asked to rate their pain level on each side of the face, using a standardized 11-point visual analogue pain scale. RESULTS: The average pain score was 4.38 +/- 2.02 for 30-gauge needles and 3.98 +/- 1.65 for 32-gauge needles. Statistical analysis via Mann-Whitney U test confirmed the null hypothesis that no statistical difference in pain level existed between the 2 needle sizes. CONCLUSIONS: There is no difference in perceived pain when comparing periocular botulinum toxin type A injections with 30- and 32-gauge needles. In addition, smaller gauge needles require special order and result in greater cost. The authors recommend continued use of 30-gauge needles for botulinum toxin injection in the office setting.

Incidence of ocular injury in visually asymptomatic orbital fractures.

PURPOSE: To determine the incidence of severe ocular injury in visually asymptomatic patients with orbital fractures. METHODS: Retrospective review of 241 cases of orbital fracture, of which 126 cases had ophthalmic evaluation within 1 week of injury and were included in our analysis. Fracture type, associated symptoms, and injuries were evaluated. Injuries were categorized into severe (requiring immediate evaluation), moderate (requiring evaluation within the next several days), and mild (may not require evaluation). The presence of symptoms and associated visual acuity and severity of injury were analyzed for statistical significance. RESULTS: Forty-six of 126 patients with orbital fractures were visually asymptomatic. Of these patients, none had severe injuries, 15 had moderate injuries, 23 had mild injuries, and 8 had no injuries. Of those with symptoms, 15 had severe injuries, 27 had moderate injuries, 35 had mild injuries, and 3 had no injuries. Using Fisher exact test analysis, asymptomatic patients were unlikely to have severe ocular injury in the setting of orbital fracture (p = 0.0009). In addition, visual acuity did not accurately predict the presence of severe ocular injury. CONCLUSION: Visually asymptomatic patients with orbital fractures do not have ocular injury requiring emergent evaluation.