Faculty Bibliography

A 58-year-old man presented with left-sided orbital inflammation, including chemosis and a lateral rectus abduction defect. Initially presumed to represent cellulitis, the condition responded poorly to oral and intravenous antibiotics. CT showed the epicenter of an infiltrate to involve the lateral rectus. The patient improved dramatically when oral prednisone was added. Lateral rectus biopsy displayed intramuscular polyclonal lymphoid infiltrates, rich with eosinophils. Complete resolution of the inflammatory process was confirmed by a follow-up CT. The presumptive diagnosis was idiopathic orbital myositis, an uncommon condition of unknown etiology. However, the patient had taken rosuvastatin, which has been rarely associated with diplopia and ophthalmoplegia, raising the question of whether this case was truly idiopathic.

OBJECTIVE:To identify the role of gender and other factors in influencing ophthalmologists' compensation. DESIGN/METHODS:Cross-sectional study. PARTICIPANTS/METHODS:U.S. practicing ophthalmologists. METHODS:Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity and number of work days. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables. MAIN OUTCOME MEASURES/METHODS:Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus. RESULTS:Of 684 respondents, 384 (56% female, 44% male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33,139.80 less than their male colleagues (12.5%, p=0.00). PSM analysis showed a SWB difference of -$27,273.89 (10.3% gap, p=0.0015). Additionally, SWB differences were calculated with the number of work days substituted by OR days [-$19727.85 (8.60% gap, p=0.0092)] and clinic days [--$27793.67 (10.5% gap, p=0.0013)] in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22261.49, $-18604.65, and $-16191.26, respectively; p=0.017, p=0.015, p=0.002). Gender independently predicted income in all 3 analyses (p<0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (p=0.03). CONCLUSION/CONCLUSIONS:Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.

Purpose : To describe clinical features requiring urgent surgical intervention for superior orbital blow-in fractures with and without globe compression. Methods : Retrospective, consecutive case series between 6/1/2018 and 12/1/2019. Results : Six patients (6 eyes) with superior orbital blow-in fractures were identified, 50% with bone fragments compressing the globe. The mean age of presentation was 31.8 +/- 10.5 years. The majority of patients were male (83%), involved the left eye (83%), and were assault victims with a swinging object (50%). All patients had periorbital edema and a brow laceration. No patients had clinical evidence of a ruptured globe. The visual acuity of the affected eye ranged from 20/20 to 20/30. Post-operative visual acuity worsened in one case (16%) due to vitreous hemorrhage. Surgical approaches included lateral orbitotomy through the brow laceration (66%), through an eyelid crease incision (17%) and a craniotomy (17%). The most common fracture types on computed tomography included communicated fractures of the frontal sinus to the superior orbital rim (83%), involvement of the zygomatic bone (33%) and an inferiorly displaced superior orbital rim (17%). Additional orbital injuries included left rectus hematoma (16%), bone fragment abutting the lacrimal gland (50%) and intraconal hematoma (33%). An intracranial injury was seen in 33% of patients, including a parieto-occipital hematoma and frontal white matter contusion. Fifty percent of patients had bone fragments directly compressing the globe with deformation of the globe contour, which was visible on fundoscopic examination and bedside ocular ultrasound. Distinguishing features of orbital blow-in fractures with globe compression compared to those without included supra-and abduction motility deficits, proptosis, globe dystopia and abnormal posterior segment exam, which were seen in all cases. Posterior segment findings included choroidal folds (100%), choroidal rupture (33%), commotio (33%) and vitreous hemorrhage (33%), however there were no retinal tears or detachments. Conclusions : In cases of periocular trauma, the presence of exophthalmos, globe dystopia, ocular motility deficits, and choroidal folds may suggest an orbital blow in fracture with globe compression. These findings should prompt expedited imaging and surgical intervention when appropriate

Pilomatrixoma, an uncommon, usually benign cutaneous appendageal tumor, shows differentiation toward the hair follicle matrix cell. It undergoes various histopathologic stages, early on displaying epithelial and shadow cells along with granulomatous inflammation. In later stages, illustrated by this unusual case, epithelial cells disappear and are replaced by calcification and ossification. Immunohistochemistry in the current case showed transitional cell reactivity for β-catenin, probably linking the tumor to a mutation in the β-catenin gene CTNNB1. There was also transitional cell positivity for cyclin D1, a marker found in matrical cells of the human hair follicle. While pilomatrixoma occurs occasionally in the eyelid, the ossified eyelid variant in the current case is very rare, with only one preceding description in the literature.

A 72-year-old woman who presented with right-sided epiphora and conjunctivitis underwent a probing and irrigation procedure with normal results. She improved with antibiotic-steroid drops. A swelling in the medial canthal region completely resolved. One year later, she returned with symptoms of dacryocystitis. An external dacryocystorhinostomy was performed. Characteristic dacryoliths were removed from the sac lumen, and biopsy of the sac wall showed spicules of lamellar bone within a fibrous stroma. Diagnosed as fibrous dysplasia of the lacrimal sac, this rare entity represents the second such case in the literature.