(in addition to PGY-3 Level goals)
Medical Knowledge
- To describe the most advanced eyelid, lacrimal, and orbital anatomy and physiology.
- To evaluate and to treat simple and more advanced eyelid, orbital, and lacrimal trauma (e.g., full thickness lid laceration, chemical burns to the face).
- To perform pre-operative and post-operative assessment and coordination of care of patients with more advanced or complex oculoplastic disorders (e.g., systemically ill patient, multi-disciplinary procedures).
- To describe the etiology, evaluation, and medical and perform or assist with the surgical treatment of the following eyelid diseases
- Ectropion (e.g., congenital, paralytic, involutional, cicatricial, mechanical, allergic).
- Entropion (e.g., involutional, cicatricial, spastic, congenital).
- Myogenic ptosis (e.g., chronic progressive external ophthalmoplegia).
- Dermatochalasis (e.g., blepharochalasis).
- Benign, pre-malignant, or malignant eyelid tumors (e.g., papilloma, keratoacanthoma, seborrheic keratosis, epidermal inclusion cyst, molluscum contagiosum, verruca vulgaris, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, melanoma).
- Single or recurrent inflammatory lesions (e.g., recurrent chalazion or its mimics).
- Facial dystonia (e.g., blepharospasm, hemifacial spasm).
- Facial nerve palsy with exposure keratopathy (e.g. tarsorrhaphy, gold weights).
- Complex lid and orbital trauma cases.
Patient Care
- To describe the indications for and to perform more complicated and advanced “in office” examination techniques for the less common but important oculoplastic and orbital abnormalities.
- To perform preoperative and intraoperative assessment of the eyelids and eyebrows (e.g., intraoperative adjustments).
- To perform more advanced lacrimal assessment (e.g., intraoperative and postoperative testing, more complex trauma to lacrimal system).
- To recognize and treat more complex or difficult socket-related problems and complications (e.g.,extrusion of implants, anophthalmic socket complications).
- To perform more complicated lid procedures (e.g., larger benign, recurrent, or multiple skin lesions.
- To describe management of and treat lacrimal system abnormalities, including:
- More complex congenital disorders (e.g., canalicular stenosis)
- Complex moderate trauma (e.g., requiring lacrimal intubation)
- To recognize typical and atypical features and to describe the differential diagnosis, clinical features, and treatment of more complicated orbital disease, including:
- More complex orbital infections (e.g., preseptal and orbital cellulitis, mucormycosis, Aspergillosis)
- Congenital tumors (e.g., dermoid)
- Fibro-osseus disorders and tumors (e.g., fibrous dysplasia, osteoma, chondrosarcoma, osteosarcoma, Paget’s disease)
- Vascular tumors (e.g., capillary hemangioma, cavernous hemangioma, hemangiopericytoma, lymphangioma, Kaposi’s sarcoma)
- Xanthomatous tumors (e.g., xanthelasma)
- Lacrimal gland tumors (e.g., benign mixed tumor, adenoid cystic carcinoma, malignant mixed tumor, lymphoma)
- Neural tumors (e.g., optic nerve glioma/meningioma, neurofibromatosis, neuroblastoma)
- Rhabdomyosarcoma
- Orbital pseudotumor
- Lymphoid lesions (e.g., lymphoid hyperplasia, lymphoma, leukemia)
- Thyroid-related orbitopathy
- Metastatic tumors (e.g., from breast, lung, prostate, colon, melanoma)
- Trauma (e.g., orbital fractures, traumatic optic neuropathy)
- Anophthalmic socket – implant exposure, volume augmentation
- To describe, recognize the indications and complications, and to assist in surgery for the eyelid procedures listed below:
- Basic biopsy techniques
- Lateral tarsal strip
- Specialized lid suture procedures (e.g., Frost sutures)
- Medial spindle
- Levator advancement
- Eyelid laceration/margin repair
- Tarsorrhaphy
- Lateral canthoplasty (canthotomy and cantholysis)
- Blepharoplasty
- Facial nerve palsy – gold weight placement in the lid
- Simple eyelid reconstruction
- Orbital approaches and incisions (e.g., lid crease, brow, lateral canthus, transconjunctival, transnasal)
- To describe, recognize the indications and complications, and assist with orbital skills and procedures
- Anterior orbitotomy for tumor biopsy/excision
- Orbital floor fracture repair
- Lacrimal gland biopsy
- To describe the indications for and to interpret CT and MRI scans (e.g., orbital trauma, orbital lesions and tumors).
- To perform simple botulinum toxin injections (e.g., blepharospasm).
- To identify more advanced orbital pathology (e.g., complex orbital fractures, orbital tumors) on imaging studies (e.g, magnetic resonance imaging, computed tomography, ultrasound)
- To describe, recognize the indications and complications, and perform temporal artery biopsy