About

Dr. Paul D. Langer is a Professor of Ophthalmology and the Director of Ophthalmic Plastic, Reconstructive, and Orbital Surgery at the Institute of Ophthalmology and Visual Science at Rutgers NJMS. He is a leading ophthalmologist in his field, with a focus on repair and reconstruction of surgical complications involving the eyelids and orbits, prevention of persistent diplopia following orbital fractures, and the epidemiology of various ocular injuries and morbidity following mid-facial trauma. Dr. Langer completed his undergraduate studies at Brown University in 1985 and earned his MD from Johns Hopkins University School of Medicine in 1989. He completed his residency at San Francisco Medical Center and a fellowship at the University of Utah. His clinical expertise includes ophthalmic plastic, reconstructive, and orbital surgery, and he is actively involved in teaching and consulting in published research with residents at Rutgers NJMS.

Research topics

• Medicine
• Pediatrics
• Surgery
• Internal medicine
• Demography
• Environmental health
• Virology
• Pathology
• Family medicine

Selected publications

• Complex Le Fort II and III Fracture With Ocular Dystopia Secondary to Asymmetric Orbital Emphysema

  Journal of Craniofacial Surgery · 2026-03-25

  article

  Le Fort fractures refer to relatively common patterns of midfacial trauma and are usually associated with symptoms such as periorbital edema, epistaxis, and maxillary immobility. This report discusses a case of a mixed Le Fort II and III fracture after a fall down the stairs, presenting with periorbital emphysema causing vertical ocular dystopia. The patient underwent successful open reduction and fixation of the fractures with miniplates with no severe complications. To our knowledge, this is the first report of Le Fort fractures presenting with bidirectional vertical dystopia.

  PublisherDOI

• Placoid Lesions in Eosinophilic Granulomatosis with Polyangiitis

  Ophthalmology · 2026-01-16

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Bibliometric analysis of published works in ocular trauma: a growing focus on open globe injury

  International Ophthalmology · 2025-01-29 · 2 citations

  review
  PublisherDOI

• Squamous Cell Carcinoma of the Conjunctiva: A Population-Based Study on Epidemiologic Trends, Cancer-Specific Survival Patterns, and the Risk of Second Malignant Neoplasms, 1975 to 2016

  Ophthalmic Plastic and Reconstructive Surgery · 2025-01-03 · 2 citations

  articleSenior authorCorresponding

  PURPOSE: To analyze the national epidemiologic trends of squamous cell carcinoma of the conjunctiva (SCCC) over 4 decades, providing the largest report on disease-specific survival (DSS) outcomes and investigating the risk of developing second primary neoplasms in these patients. METHODS: This retrospective, population-based cohort study analyzed 1,172 patients diagnosed with SCCC from January 1, 1975, through December 31, 2016. Data were extracted from the US Surveillance, Epidemiology, and End Results database. Incidence, DSS, and the relative risk (95% confidence interval) of developing second primary neoplasms were studied. RESULTS: SCCC incidence (0.45/million/year) increased during the study's time period (regression coefficient = 0.004, p = 0.002), primarily due to an increasing incidence in women (regression coefficient = 0.004, p = 0.003) and in White (regression coefficient = 0.006, p = 0.007) patients. The 5-year DSS was 95.4%. Sex and race did not impact survival. Patients residing in the Midwestern United States exhibited the lowest survival compared with other regions with a 5-year DSS of 85.2% ( p = 0.008). White male SCCC patients are at an increased risk, compared with the general population, of developing second primary neoplasms of the liver (relative risk = 4.8 [1.3-12.4]; p < 0.05), respiratory tract (relative risk = 2.3 [1.4-3.6]; p < 0.05), and skin (relative risk = 3.7 [1.8-6.9]; p < 0.05). CONCLUSIONS: SCCC incidence has been increasing in the United States. DSS is substantially higher than the overall survival previously reported in the literature. The area of residence significantly impacts survival. White men with SCCC are at an increased risk of developing second primary neoplasms of different organ systems.

  PublisherDOI

• Lacrimal Sac Inverted Papilloma Containing Mucin-Secreting Carcinoma

  Ophthalmology · 2025-04-09

  articleSenior author
  PublisherDOI

• Lymphoepithelial Cysts of the Lacrimal Glands in Sjogren Syndrome

  Ophthalmology · 2025-04-09

  articleSenior author
  PublisherDOI

• ABS0986 PATIENT-REPORTED DISEASE ACTIVITY AND FLARE STATUS ASSESSED BY THE SYSTEMIC LUPUS ACTIVITY QUESTIONNAIRE (SLAQ)

  Annals of the Rheumatic Diseases · 2025-06-01

  articleOpen access

  <h2>Abstract</h2><h3>Background:</h3> Systemic lupus erythematosus (SLE) is characterized by heterogeneous, waxing and waning clinical manifestations, leading to substantial physical and psychological burden. Active disease and repetitive flares correlate with increased fatigue, pain, and accumulation of organ damage [1–3]. Patient-reported outcome measures, such as the Systemic Lupus Activity Score (SLAQ) are increasingly recognized for their role in capturing the patient experience and could be integrated as relevant outcome in therapeutic trials. <h3>Objectives:</h3> This study aims at assessing the current state of self-reported disease activity and understanding the factors that contribute to disease activity in Swiss SLE patients. <h3>Methods:</h3> In this cross-sectional study, patients living in Switzerland were invited to participate in the online survey via 3 different channels: i) digital advertisements targeted to SLE patients (google search and ads), ii) newsletter of a lupus patient association (Lupus Suisse), and iii) letters to patients of a national Lupus registry (Swiss SLE Cohort Study, SSCS). Patients with self-reported physician's diagnosis of SLE, aged ≥ 18 years, willing to provide electronic consent for the study, residing in Switzerland and able to read and complete the survey in German, French or Italian were included in the study. Disease activity was assessed using the Systemic Lupus Activity Questionnaire (SLAQ). The SLAQ, a patient-reported assessment of subjective disease activity in SLE, consists of questions on 24 specific symptoms resulting in a symptom score (ranging from 0 to 24) and a weighted total score (ranging from 0 to 47). Furthermore, SLAQ covers the presence of flares, and a patient global assessment of disease activity (ranging from 0-10) [4]. The survey also included questions regarding age, gender, region of living, treatment modalities, and treatment satisfaction (6 dimensions derived from the Lupus Europe survey [5]), providing a holistic view of the patients' experience. Median and IQR were calculated for descriptive statistics, mean values, and standard deviations for score calculations. To build high and low disease activity strata, the respective median was applied. Comparisons between independent groups were made using the Mann-Whitney U test for continuous and the Fisher's exact test for categorical data, without correction for multiplicity due to the exploratory nature of the survey. Multiple linear regression was used to explore associations between SLAQ total score and independent variables. The study was approved by the Cantonal Ethics Committee of Geneva (2023-01927). <h3>Results:</h3> Between February 14th and June 25th, 2024, 282 patients were screened, of which 27 did not meet the inclusion criteria. Out of the remaining 255 patients, 109 participants left the online survey incomplete, leaving a total of 146 patients included in the analysis. Participants had a median age of 48.5 years, were predominantly female (85.6%) and Caucasians (76.7%). Median duration of SLE was 12 years and mostly used SLE medications were antimalarials (73.3%), immunosuppressants (36.3%), and glucocorticoids (GC) (34.2%). 56% of patients on GC indicated to take more than 5mg/day. The mean SLAQ total score was 19.35 and the overall disease activity 3.86. Moderate to severe flares in the last 3 months were reported by 28.7% of patients. From the patients that did not report a flare or had a mild flare only 6.7% indicated not to be on medication (Table 1). The regression analysis (adjusted for patient demographics, medication, disease duration, and disease activity) showed a significant positive correlation between SLAQ total score and disease activity (β = 0.587, p < 0.01), having flares (β = 0.512, p < 0.01) and daily pill intake (β = 0.237, p=0.014). Average treatment usage depending on high/low SLAQ scores shows a higher usage of NSAIDs in patients with high disease activity (36.5% vs. 19.4%, p<0.01, Figure 1). Furthermore, antidepressants or anxiolytics were used more frequently in patients with high vs. low SLAQ total scores (36.2% vs. 10.0%, p<0.01). Average treatment satisfaction across all 6 dimensions was lower in patients with high disease activity (57.2% vs 75.2%, p<0.01). <h3>Conclusion:</h3> These findings show the persisting disease burden in patients with SLE in Switzerland underscored by substantial disease activity, existence of flares and high usage of GC. Furthermore, the study reveals an association between increased disease activity and treatment patterns as well as overall treatment satisfaction. However, prospective studies are needed to better understand the causal relationship between these outcomes and self-reported disease activity. <h3>REFERENCES:</h3> [1] Chaigne B, Chizzolini C, Perneger T, et al. Impact of disease activity on health-related quality of life in systemic lupus erythematosus – a cross-sectional analysis of the Swiss Systemic Lupus Erythematosus Cohort Study (SSCS). <i>BMC Immunology</i> 2017; <b>18</b>(1): 17. [2] Fanouriakis A, Tziolos N, Bertsias G, Boumpas DT. Update on the diagnosis and management of systemic lupus erythematosus. <i>Annals of the Rheumatic Diseases</i> 2021; <b>80</b>(1): 14-25. [3] Katz P, Nelson WW, Daly RP, Topf L, Connolly-Strong E, Reed ML. Patient-Reported Lupus Flare Symptoms Are Associated with Worsened Patient Outcomes and Increased Economic Burden. <i>J Manag Care Spec Pharm</i> 2020; <b>26</b>(3): 275-83. [4] Karlson E, Ma H, Rivest C, et al. Validation of a Systemic Lupus Activity Questionnaire (SLAQ) for population studies. <i>Lupus</i> 2003; <b>12</b>: 280-6. [5] Cornet A, Andersen J, Myllys K, Edwards A, Arnaud L. Living with systemic lupus erythematosus in 2020: a European patient survey. <i>Lupus Sci Med</i> 2021; <b>8</b>(1). <b>Table 1.</b> Patient and treatment characteristics. Figure 1SLE medication distribution depending on low/high SLAQ total score. * = p<0.01 <h3>Acknowledgements:</h3> <b>NIL</b>. <h3>Disclosure of Interests:</h3> Philipp Wörner Global ETF, AstraZeneca, Jasmin Annabelle Schäfer: None declared, Kristin Schmiedeberg: None declared, Marten Trendelenburg Research collaborations with Roche, Novartis and Idorsia (all Switzerland), Johannes von Kempis: None declared, Chiara Balbo Pogliano AstraZeneca, Peter Langer AstraZeneca, Shekoofeh Yaghmaei AstraZeneca, Carlo Chizzolini AstraZeneca, Boehringer Ingelheim (less than 10,000 Euro). © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

  PublisherDOI

• Ophthalmologic Complications in Coronavirus Disease 2019 Immunization: A National Vaccine Adverse Event Reporting System Analysis

  Ophthalmology · 2024-01-18 · 3 citations

  articleOpen access

  In this Vaccine Adverse Event Reporting System disproportionality analysis, COVID-19 immunization was rarely and generally not significantly associated with ophthalmologic complications. However, some symptoms were positive on Janssen vaccination, suggesting a need for continued investigation. In this Vaccine Adverse Event Reporting System disproportionality analysis, COVID-19 immunization was rarely and generally not significantly associated with ophthalmologic complications. However, some symptoms were positive on Janssen vaccination, suggesting a need for continued investigation.

  PublisherOA PDFDOI

• Clinical Report on the Epidemiology of Pediatric Dog Bite-Associated Ocular Injuries

  Journal of Pediatric Ophthalmology & Strabismus · 2024-07-01 · 1 citations

  letterOpen access

  To the Editors:Dog-bite associated ocular trauma includes a diverse range of injuries, with acute and chronic complications requiring careful management. 1 In school-aged children, dog bites have been identified as a cause of significant ophthalmic injury. 1 Children bitten by dogs are more than four times more likely to suffer from ocular injuries than adults, and children are twice as likely as adults to suffer from a periorbital dog bite. 2 Facial dog bites can also result in open globe injury without an eyelid laceration or contusion, thus warranting a complete ophthalmic evaluation in all pediatric periorbital dog bite injuries. 3Even in cases with early and appropriate surgical management, complications necessitating revision surgery are relatively common, having occurred at a rate of 14% at a single institution retrospective review at a large tertiary pediatric hospital. 4Understanding the epidemiology of dog bite-related ocular injuries occurring nationally can better inform guidelines and safety recommendations for vulnerable patient groups.Therefore, the purpose of this project was to use the National Trauma Data Bank (NTDB) to describe the epidemiological trends in pediatric (younger than 19 years) dog bite-associated ocular injuries occurring in the United States.Cases were identified using the NTDB, a national database reporting information from participating institutions on emergency department visits resulting in admission, mortality during the encounter, or transfer to another hospital. 5This analysis describes trends in dog bite-associated pediatric cases spanning from 2007 to 2014.Ocular injuries were identified using ICD-9 CM codes.Multivariate logistic regression models were used to identify factors associated with ocular trauma secondary to dog bites.Statistical analysis was performed using IBM SPSS 23 software (IBM Corporation).Overall, 6,231 cases of dog bite-associated ocular injury were documented by the NTDB during the 8-year period, for which the median (interquartile range) age was 5 years (range: 2 to 9 years).Further

  PublisherOA PDFDOI

• Epidemiology of motor vehicle accident-associated ocular trauma

  International Ophthalmology · 2024-11-18 · 2 citations

  articleOpen accessSenior author

  PURPOSE: The objective is to investigate trends in cases of motor vehicle accident-associated (MVA-associated) ocular trauma in which the patient was the driver of the motor vehicle. METHODS: The study utilizes data from the 2007-2014 National Trauma Databank (NTDB), a national trauma registry. Status as the driver of the motor vehicle was identified using E-Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Trauma diagnoses were identified using D-Codes from the ICD-9-CM. Statistics were performed using IBM SPSS Version 23. RESULTS: We identified 49,660 cases of ocular trauma secondary to an MVA with a 25.3% increase in injuries over the 8-year time period. Men comprised 68.6% (34,057) of cases. Orbital floor fractures (OFFs) were the most commonly observed ocular injury, occurring in 17,647 (35.5%) cases. There were 2,787 cases of open globe injury (OGI) with the highest proportion of cases in the 65 + age group (6.5%). OGIs were seen in 3.0% of cases with OFFs vs. 7.1% in those without. Drivers under 18 were more likely to have optic pathway/cranial nerve injuries (4.4%) and ocular/adnexal contusions (41.2%) than adult drivers. The mortality rate was 4.3% and was highest in the 65 + age group (9.4%). CONCLUSION: Men and young adults comprised the majority of cases of MVA-associated ocular trauma. OFFs were seen in approximately one-third of cases of ocular trauma. OGIs were less commonly observed when a concurrent OFF was observed. Though the overall mortality was 4.3%, there was significant variation by age group.

  PublisherOA PDFDOI

Frequent coauthors

• Neelakshi Bhagat

  Toronto Metropolitan University

  151 shared

• Marco A. Zarbin

  Rutgers, The State University of New Jersey

  137 shared

• Roger E. Turbin

  Rutgers, The State University of New Jersey

  100 shared

• Neena Mirani

  Rutgers, The State University of New Jersey

  86 shared

• Alain Bauza

  71 shared

• Jean Anderson Eloy

  Neurological Surgery

  67 shared

• Tatyana Milman

  Thomas Jefferson University

  37 shared

• Aditya Uppuluri

  Rutgers New Jersey Medical School

  36 shared

Education

• B.A.

  Brown University

  1985

• M.D.

  Johns Hopkins University School of Medicine

  1989