PGY-4 Goals & Objectives

(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