Oncology Expert Opines on ‘Unnecessary’ Eye Surgery


Oncology Expert OperatesIn this case, an oncology expert was called in by the plaintiff to evaluate the necessity of ocular surgery preformed by the defendant. A surgeon in her 40s underwent a right eye surgical procedure performed by defendant. The procedure was to be an excision of a mass on the eyelid over her right eye, but the defendant instead did an orbitotomy. The pathology showed a benign eyelid sweat gland cyst called a hydrocystoma and chronic dacryocystitis. The defendant agreed with the pathologist’s diagnosis of hydrocystoma and felt that the plaintiff had dacryoadenitis rather than dacryocystitis.

Plaintiff alleges that she did not provide informed consent for the procedure actually performed, and that the surgery was unnecessary. As a direct result of this surgery, the plaintiff suffers from dry eye syndrome, ptosis, severe corneal abrasions, and eye pain. These side effects of the eye surgery prevent her from performing surgeries.

Question(s) For Expert Witness

  • 1. Was the eye surgery necessary?
  • 2. What was the standard of care?
  • 3. Was it breached?

Expert Witness Response

An eyelid eccrine hidrocystoma is correctly identified 90% of the time by ophthalmologists, and 82 percent of eyelid tumors are benign. Eccrine hidrocystoma is treated with simple excision and does not recur. Chronic dacryoadenitis presents as a painless enlargement of the lacrimal gland. This is easily differentiated from a malignant lacrimal gland tumor by accurate history and physical examination, and radiographic imaging, which is standard practice.

As a direct result of defendant disregarding the standard of medical and ophthalmologic care as outlined by numerous organizations, including the American Medical Association and the American Association of Ophthalmologists, plaintiff had an unnecessary surgery, which she had not consented to. This surgery left her with permanent consequences that are having, and will continue to have significant impact on her financial, personal and occupation security and quality of life.

Regarding the informed consent, the defendant failed to give the plaintiff complete information about her diagnosis, treatment, and prognosis. He failed to give her all the information she needed to make an informed consent for the procedure. He did not describe alternative treatments/procedures or provide a list of risks associated with the procedure.

An orbital MRI or CT would have been ordered to complete the work up of a lacrimal gland mass. More probably than not, the diagnosis of benign chronic dacryoadenitis would have been made and conservative nonsurgical management recommended. The hidrocystoma would have been treated with simple excision or marsupialization with destruction of the cyst wall. A reasonable, fully informed patient in plaintiff’s position would have refused to undergo an invasive orbitotomy.

An eyelid eccrine hidrocystoma is correctly identified 90% of the time by ophthalmologists, and 82 percent of eyelid tumors are benign. Eccrine hidrocystoma is treated with simple excision and does not recur. Chronic dacryoadenitis presents as a painless enlargement of the lacrimal gland. This is easily differentiated from a malignant lacrimal gland tumor by accurate history and physical examination, and radiographic imaging, which is standard practice.

As a direct result of defendant disregarding the standard of medical and ophthalmologic care as outlined by numerous organizations, including the American Medical Association and the American Association of Ophthalmologists, plaintiff had an unnecessary surgery, which she had not consented to. This surgery left her with permanent consequences that are having, and will continue to have significant impact on her financial, personal and occupation security and quality of life.

Regarding the informed consent, the defendant failed to give the plaintiff complete information about her diagnosis, treatment, and prognosis. He failed to give her all the information she needed to make an informed consent for the procedure. He did not describe alternative treatments/procedures or provide a list of risks associated with the procedure.

An orbital MRI or CT would have been ordered to complete the work up of a lacrimal gland mass. More probably than not, the diagnosis of benign chronic dacryoadenitis would have been made and conservative nonsurgical management recommended. The hidrocystoma would have been treated with simple excision or marsupialization with destruction of the cyst wall. A reasonable, fully informed patient in plaintiff’s position would have refused to undergo an invasive orbitotomy.

The expert is board certified as an internist, hematologist and medical oncologist with extensive experience with benign and malignant tumor diagnosis, work-up and management issues.

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