Faculty Bibliography

Purpose: The purpose of this study is to evaluate medical student perception of the current ophthalmology curriculum without mandatory rotation at New York University School of Medicine (NYUSOM). Despite the lack of emphasis on ophthalmology in many medical school curricula, eye examination and management skills are important for physicians to master because they can reveal systemic pathology and require emergent treatment. In the context of rapidly evolving medical school curricula and lack of national ophthalmology education standards, it is important to assess ophthalmology training adequacy.
Method(s): A cross-sectional Internet survey was distributed to all currently enrolled NYUSOM students, including those pursuing dual degrees, in March to May 2017. The main parameters measured in the study were students' self-reported confidence with ophthalmology skills and satisfaction with curriculum.
Result(s): Response rate was 27.5% (166 of 604) of NYUSOM students. Many students reported they were not comfortable diagnosing eye emergencies (64%), using a direct ophthalmoscope (71%), or testing visual acuity (50%). The majority of students did not want ophthalmology to become a mandatory rotation, but reported additional in-person training would be most helpful, compared to videos, web-based didactics, lectures, or virtual training. Completion of an ophthalmology elective and more hours of ophthalmology training were associated with increased confidence with eye examination and greater satisfaction with the curriculum.
Conclusion(s): It is critical for all physicians-in-training to have adequate skills in eye examination. Identifying areas of improvement and determining the best teaching modality will be important in updating the ophthalmology curriculum for medical students. The majority of medical students are not at all or only slightly confident with eye examinations. Increasing the amount of in-person ophthalmology training in medical school improves confidence with eye examination. (Figure presented)

The authors describe an esthesioneuroblastoma (olfactory neuroblastoma) that occurred within the nasal cavity and brain in a 31-year-old man. Following excision, the tumor recurred in the left orbit and in mediastinal lymph nodes. Treatment included orbital excision and systemic chemotherapy. Histopathology showed a high-grade neuroepithelial tumor with positive immunohistochemical markers for neuroendocrine and epithelial components, an unusual combination raising issues concerning taxonomy.

Purpose: To analyze the surgical management and outcomes of patients with canalicular lacerations and to report the epidemiological data and clinical characteristics of this group of patients. Methods: A retrospective review of medical records of all patients with canalicular lacerations from 1992 to the present at a single institution. Results: A total of 50 patients with injury to the canalicular system were identified, mean age 32 years (range 16 months - 88 years), 82% were male and 18% female. 82% were adult and 18% were pediatric patients. The most common mechanism of injury in adults was assault (50%) while in children it was accidents with objects (33%). 86% were found to have injury to one canaliculus while 14% had a bicanalicular laceration. 68% of the canaliculi injured were lower lid, 32% were upper lid. 78% of the lacerations were graded as mild or moderate and 22% were severe, with associated medial canthal avulsion or extensive globe or orbital injury. 94% proceeded to repair within 48 hours; in two patients, canalicular intubation could not be achieved intraoperatively. Of the 48 patients who underwent surgical repair, 22% had monocanalicular intubation with the Mini-Monoka and 78% percent had repair with the Crawford tube. All (100%) bicanalicular lacerations were repaired with the bicanalicular Crawford tube. The majority of monocanalicular lacerations (78%) were repaired with either the monocanalicular or bicanalicular Crawford tube; all (100%) of the lacerations repaired with the Mini-manoka were mild. Thirty patients had follow up beyond post-operative month 1, with an average follow-up of 6 months. The average length of intubation was 5.7 months. 93% of patients had successful functional and anatomic outcomes. The most common complication was tube extrusion requiring repositioning or repeat surgery, which occurred at the same rate (17%) with the Mini-Monoka and Crawford tube. In two such instances, one type of stent was replaced for another secondary to patient anatomy. Conclusions: In our experience, most canalicular lacerations are sustained by adult males and are related to assault. The majority of canalicular lacerations are repaired with bicanalicular Crawford tubes within 48 hours. Both methods of repair, Mini Monoka stent and Crawford tube, are effective in achieving good outcome and it is important to be familiar with the use of both

PURPOSE: To report a case of bilateral iritis and transillumination defects after laser hair removal of the eyebrows with an alexandrite laser. METHODS: A 41-year-old male presented with bilateral eye pain and mild photophobia 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Examination showed visual acuity of 20/20 in both eyes, 2+ conjunctival injection in both eyes, 1+ cells in the anterior chamber of right eye and trace cells in left eye, poor right pupil dilation, and left pupil without movement. Intraocular pressure and fundus examination were normal. He was diagnosed with iritis and iris atrophy, associated with laser epilation. Topical steroids and cycloplegic drops were prescribed for 1 month. RESULTS: After 1 month of treatment, transillumination defects remained in both eyes, but greater in right. In dim light, the right pupil was 4 mm and oval and the left pupil was 6 mm and round. Visual acuity remained 20/20 in both eyes. CONCLUSION: Laser hair removal of the eyebrows can lead to permanent ocular damage even with eye protection, and should be avoided.

PURPOSE: To report a case of bilateral endogenous fungal endophthalmitis resulting from disseminated Scedosporium prolificans. DESIGN: Observational case report. METHODS: A 56-year-old woman with cystic fibrosis status post dual lung transplantation on chronic immunosuppressive therapy presented with acute graft rejection. Cultures of bronchial brushings revealed S. prolificans. Three weeks after admission, the patient noted increased blurriness and a central scotoma in her right eye. Dilated fundus examination revealed profound vitritis in the right eye with hemorrhagic retinitis involving the macula. A peripheral, yellow choroidal infiltrate with overlying retinitis and localized vitritis was present in the left eye. RESULTS: Intravitreal antibiotics were initiated, and vitreous cultures revealed S. prolificans. The patient ultimately succumbed to her disseminated disease. Pathologic examination of the eyes confirmed bilateral endogenous fungal endophthalmitis. CONCLUSION: S. prolificans is an opportunistic infection resistant to standard antifungal therapy that can result in endogenous endophthalmitis in immunocompromised individuals.