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Accuracy in clinical diagnosis of periocular lesions by ophthalmology residents [Meeting Abstract]

Dempsey, K; Palu, R N
Purpose : Previous studies of ophthalmology attendings' clinical diagnosis of periocular lesions suggest a high degree of accuracy. We performed a retrospective, observational, quality improvement study to evaluate whether resident ophthalmologists provided an accurate clinical diagnosis of periocular lesions as compared to the final histopathologic diagnosis on biopsy. Methods : We reviewed the biopsy log of a resident-run oculoplastics clinic from 2/1/18 to 12/1/19 to identify the clinical and histopathologic diagnosis for biopsies of eyelid and tarsus lesions. Lesions without clear clinical diagnosis or narrow differential were excluded, as were those with uninterpretable or equivocal histopathologic findings. The ophthalmology resident's clinical diagnosis and the pathologist's final histopathologic diagnosis were compared for concordance with descriptive statistics. IRB exemption was obtained. Results : Of 150 biopsies identified, 120 were included. 22 were excluded for lack of clinical diagnosis; 4 were excluded for an uncertain histopathologic diagnosis; and 4 samples were inadequate. The clinical diagnosis was concordant with the histopathologic diagnosis in 94 of 120 biopsies (78.4%). Three lesions were malignant, all of which were correctly assessed as basal cell carcinomas. Among benign lesions, concordance was highest in lesions clinically diagnosed as hidrocystomas (18/20 biopsies, 90.0%), chalazia (10/12, 83.3%), and benign squamous papillomas/fibroepithelial polyps (35/45, 77.8%). Seborrheic keratosis (SK) was frequently clinically misdiagnosed. In 6/6 cases where the clinical diagnosis was SK, the pathology were concordant, but there were 14 additional cases of biopsy-proven seborrheic keratosis, the clinical diagnosis was verruca vulgaris, papilloma, basal cell carcinoma, or nevus. Conclusions : Ophthalmology residents had a high degree of accuracy in clinical diagnosis of benign periocular lesions. Seborrheic keratosis was frequently misdiagnosed clinically and was identified as an area for improved resident education. A limitation of this study is paucity of malignant lesions, as residents' accuracy in their diagnosis was not able to be assessed. In addition, this retrospective quality improvement study was limited in scope; factors not assessed included the reason for biopsy, the training level of the resident, and whether the resident's and attending's clinical diagnosis agreed
ISSN: 1552-5783
CID: 4586192

Orbital Extension of Conjunctival Pseudoadenomatous Hyperplasia

Charles, Norman C; Palu, Richard N
A 41-year-old woman developed persistent unilateral conjunctivitis following an upper respiratory infection. A white cystic lesion of the inferior fornix was noted on computed tomography scan to extend behind the orbital septum into the anterior portion of the orbit. Following subtotal excision, histopathology showed benign pseudoadenomatous (pseudoglandular) hyperplasia. The case represents the 5th report of this lesion occurring in the conjunctiva and the only instance of its extension into the orbit.
PMID: 29979270
ISSN: 1537-2677
CID: 3186222

Amelanotic Cellular Blue Nevus of the Eyelid

Charles, Norman C; Meehan, Shane A; Palu, Richard N
The authors describe an isolated, yellowish papular lesion of the upper eyelid in a 63-year-old man. Following excision, histopathologic analysis showed the features of a benign hypopigmented cellular blue nevus, the first and only case involving the eyelid skin.
PMID: 27930423
ISSN: 1537-2677
CID: 2354362

Location of the Zygomatico-orbital Foramen on the Inferolateral Orbital Wall: Clinical Implications

Patel, Payal; Belinsky, Irina; Howard, David; Palu, Richard N
Abstract Purpose: To describe the location of the zygomatico-orbital foramen on the inferolateral orbital wall. Methods: This anatomic study examined 28 orbits of 14 dry human adult skulls. The zygomatico-orbital foramen was identified by passing a thin wire from the zygomatico-facial foramen to its orbital aspect and a thin flexible ruler was used to measure 1) the distance perpendicular to the closest point on the inferior orbital rim, 2) the distance from the inferior orbital fissure, and 3) the distance from the area used for retrobulbar injections. Results: The mean distance from the zygomatico-orbital foramen to the closest point on the inferior orbital rim was 4.7 mm (range from 1 to 7 mm). The mean distance from the inferior orbital fissure was 14.9 mm (range from 10 to 18 mm). The mean distance from the area of retrobulbar injection was 6.0 mm (range from 3 to 10 mm). Conclusions: The location of the zygomatico-orbital foramen within the inferolateral orbit is quite variable. This is the first study to attempt to quantify its proximity to the site of retrobulbar injection. We conclude that it is an important anatomical structure to consider when giving retrobulbar anesthesia, especially given the variability in technique among ophthalmologists.
PMID: 23875643
ISSN: 0167-6830
CID: 529062

Distracted pedestrian sustains orbital fracture while on cell phone

Edell, Aimee R; Jung, Jesse J; Solomon, Joel M; Palu, Richard N
Use of cell phones in the general population has become increasingly commonplace. The distracting effects of cell phones among automobile drivers are well established, and legislation prohibits the use of handheld cell phones while driving in several states. Recent research has focused on the similar distracting effects of cell phones in the pedestrian population. In this report, an older gentleman suffered extensive facial trauma requiring surgery as a direct effect of cell phone use at the time the trauma occurred. This case highlights the role that portable electronic devices can play as a cause of ocular trauma.
PMID: 23579597
ISSN: 1177-5467
CID: 301322

Epiphora and Dacryocystorhinostomy

Chapter by: Palu, Richard N
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 793-797
ISBN: 3642234992
CID: 1808082

Reply re: "Orbital Dissemination of Lemierre Syndrome From Gram-Positive Septic Emboli" [Letter]

Kahn, Jonathan B.; Baharestani, Samuel; Zoumalan, Christopher I.; Warren, Floyd A.; Palu, Richard N.
ISSN: 0740-9303
CID: 146011

Orbital dissemination of lemierre syndrome from gram-positive septic emboli

Kahn, Jonathan B; Baharestani, Samuel; Beck, Heather C; Ng, Diana; Zoumalan, Christopher I; Warren, Floyd A; Palu, Richard N
A 45-year-old patient presented with bilateral orbital abscesses. He was found to have Lemierre syndrome, a condition involving septic thrombophlebitis of the internal jugular vein. The patient developed severe proptosis, sepsis, and cavernous sinus thrombosis. Despite aggressive antibiotic and anticoagulation therapy, visual loss was rapid, and the patient ultimately died. Lemierre syndrome, previously thought to be rare, is now becoming more commonly reported. Its prompt diagnosis and treatment are essential for patient survival
PMID: 21566465
ISSN: 1537-2677
CID: 132587

Modified tarsorrhaphy for management of the eye in facial nerve palsy

Morris, Luc G; Palu, Richard N; DeLacure, Mark D
PMID: 16826081
ISSN: 0023-852x
CID: 67536

Intramuscular lipoma of the eyelid [In Process Citation] [Case Report]

Charles NC; Palu RN
To report a unique case of intramuscular lipoma of the eyelid and to alert surgeons to this entity that simulates a common dermoid cyst. A slowly-growing mass of the upper eyelid was excised from a 62-year-old man. Histology showed mature lipocytes interspersed with skeletal muscle. To our knowledge, this case represents the first report of intramuscular lipoma of the eyelid. Lipomas, including the intramuscular variety, are common tumors elsewhere in the body. The differential diagnosis of eyelid masses should include this entity
PMID: 10928675
ISSN: 1082-3069
CID: 11565