title: In the eyes of the law: malpractice litigation in oculoplastic surgery.
abstract: OBJECTIVE
  To assess characteristics associated with various outcomes of malpractice litigation, resulting from injuries sustained during oculoplastic procedures.
  
  
  METHODS
  The Westlaw legal database (Thomson Reuters, New York, NY, U.S.A.) was used to obtain jury verdicts and settlements. Pertinent data were extracted from 69 malpractice cases litigated from 1988 to 2012 involving oculoplastic procedures, including alleged cause of malpractice, outcome, and defendant specialty.
  
  
  RESULTS
  The most commonly litigated surgical procedures were blepharoplasty (63.8% of total) and brow lift surgery (11.6%). The most commonly alleged complications included excessive scarring (24.6%), lagophthalmos (24.6%), visual defects (23.2%), and exposure keratitis (21.7%). Plastic surgeons were the most commonly named defendants (46.4%), followed by both comprehensive ophthalmologists and fellowship-trained ophthalmic plastic surgeons (17.3% each). A defense verdict was held in 60.9% of cases, a plaintiff verdict in 31.9% of cases, and a settlement was reached in 7.2% of cases. Blindness, cranial nerve injury, and the allegation of a permanent deficit increased the likelihood of a case being resolved with payment to the plaintiff (Fisher exact tests, p < 0.05).
  
  
  CONCLUSIONS
  Most litigated oculoplastic malpractice cases were resolved in favor of the defendant, while settlements and plaintiff decisions averaged $455,703. Blepharoplasty constituted two-thirds of cases, with the most frequently cited associated complications being unsightly scarring, lagophthalmos, and visual deficits. An alleged lack of informed consent (30.4%) or the need for additional surgery (39.1%) was present in a considerable proportion of cases, emphasizing the importance of a detailed informed consent and clear communication preoperatively regarding patient expectations.
authors.affiliation: Departments of *Ophthalmology and Visual Science, and †Otolaryngology-Head and Neck Surgery, Rutgers, New Jersey Medical School, Newark, New Jersey, U.S.A.; ‡The University of Michigan Law School, Ann Arbor, Michigan; and §Department of Neurological Surgery, and ‖Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Blake
authors.forename: Qasim
authors.initials: Q
authors.lastname: Husain
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Mauro
authors.forename: Roger E
authors.initials: RE
authors.lastname: Turbin
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Paul D
authors.initials: PD
authors.lastname: Langer
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007258:Informed Consent; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000331:legislation & jurisprudence*; D009885:Ophthalmology / Q000331:legislation & jurisprudence*; D013518:Surgery, Plastic / Q000331:legislation & jurisprudence*; D014481:United States