About

Don O. Kikkawa is a Professor of Clinical Ophthalmology at UC San Diego School of Medicine. His research focuses on various aspects of ophthalmology, including thyroid eye disease, orbital inflammation, eyelid surgery, and orbital tumors. He has contributed to understanding the systemic effects of treatments such as teprotumumab on thyroid function and extraocular muscle volume, as well as exploring innovative surgical techniques for eyelid and orbital reconstruction. His work involves investigating biomarkers, imaging modalities, and surgical outcomes to improve patient care in ophthalmic and oculofacial conditions.

Research topics

• Medicine
• Internal medicine
• Surgery
• Immunology
• Dermatology
• Pathology
• Ophthalmology

Selected publications

• CT-guided biopsy with fine-needle via the anterior approach in the diagnosis of orbital lymphoma: a case series

  Orbit · 2026-04-08

  article

  BACKGROUND: To evaluate the clinical efficacy of CT-guided biopsy via the anterior approach in diagnosing orbital lymphoma. METHODS: From November 2018 to July 2021, 11 patients suspected of having orbital lymphoma based on imaging were selected from the Second Hospital of Dalian Medical University. Each patient underwent a CT-guided biopsy using a semi-automatic 18 G needle. Biopsies were performed under local anesthesia, and the obtained tissue samples were analyzed for a definitive diagnosis. RESULTS: Adequate tissue samples were successfully obtained in all 11 cases. Of these, 7 patients (63.6%) were diagnosed with lymphoma, including subtypes such as extranodal marginal zone B-cell lymphoma, diffuse large B-cell lymphoma, and mantle cell lymphoma. Other diagnoses included IgG4-related ophthalmic disease (9.1%), and chronic inflammatory hyperplasia (27.3%). A small subcutaneous hematoma occurred in 1 patient (9.1%), which resolved without additional intervention. CONCLUSION: CT-guided biopsy via the anterior approach is an effective technique for diagnosing orbital lymphoma. It is cost-effective, minimally invasive, allows for quicker recovery, and is associated with fewer adverse events compared to traditional surgical biopsy.

  PublisherDOI

• Intersurgeon Variability in Proptosis Reduction After Orbital Decompression for Thyroid Eye Disease: A Multicenter Analysis

  Ophthalmic Plastic and Reconstructive Surgery · 2025-10-13

  articleSenior authorCorresponding

  PURPOSE: This study assesses intersurgeon variability in proptosis reduction after orbital decompression for thyroid eye disease. METHODS: This multicenter retrospective study included patients with thyroid eye disease who underwent orbital decompression from 1 of 7 surgeons at 7 different institutions between January 2002 and December 2018. Data were included if a single decompression technique was performed on ≥10 patients by ≥2 surgeons. The primary outcome was postoperative change in proptosis with emphasis on comparison among surgeons utilizing similar surgical techniques. Statistical analysis was performed with χ 2 and ANOVA testing, and a multivariable logistic regression model was generated. RESULTS: Six hundred thirty-three orbits that underwent orbital decompression were included. Five different decompression techniques were analyzed: medial wall (n = 29), fat + lateral wall (n = 113), medial wall + floor (n = 123), fat + lateral wall + medial wall (n = 140), and fat + lateral wall + medial wall + floor (n = 228), without significant difference in proptosis reduction among surgeons. Surgeons did not demonstrate significant differences in outcomes at different time points compared with each other or themselves. Outcomes when comparing endoscopic versus open medial wall decompression varied among surgery types. Multivariate modeling revealed a statistically significant association between postoperative change in proptosis with preoperative proptosis ( p < 0.001). CONCLUSIONS: Postoperative change in proptosis did not differ significantly between surgeons utilizing similar orbital decompression techniques for patients with thyroid eye disease. This study may strengthen the statistical validity of multicenter clinical trials assessing orbital decompression outcomes performed by surgeons employing uniform surgical techniques, thereby advancing our understanding of optimal surgical management strategies for thyroid eye disease.

  PublisherDOI

• Bilateral Retrobulbar Hemorrhage After Asphyxiation

  Ophthalmic Plastic and Reconstructive Surgery · 2025-11-27

  articleSenior authorCorresponding

  A 48-year-old woman presented to the emergency department with acute bilateral eye pain, diplopia, and blurry vision. Her examination was notable for reduced supraduction OD, with a diffuse facial petechial rash, significant periorbital ecchymosis, upper eyelid ptosis, and subconjunctival hemorrhage (Fig. 1). The patient’s visual acuity was 20/20 OU without afferent pupillary defect, with normal intraocular pressures and dilated fundus examination. She denied a medical history of coagulopathies, anticoagulant use, or recent periorbital procedures. Further history revealed that the patient had undergone consensual erotic manual strangulation with her partner and suffered immediate loss of consciousness with presenting symptoms after a short period of strangulation. CT scan (Fig. 2A–C) showed bilateral retrobulbar stranding concerning for hemorrhage and right orbital superior extraconal hematoma (black arrow) with mild mass effect on the superior rectus and levator palpebrae superioris, as well as right-sided proptosis with mild straightening of the optic nerve (asterisk). There was no clinical evidence of orbital compartment syndrome, and the decision was made to monitor the patient. On follow-up 4 months after initial injury, the patient reported complete resolution of her pain and double vision, with no persistent cosmetic defects. Retrobulbar hemorrhage is a rare but potentially vision-threatening finding in orbital trauma. Few reports have been published describing retrobulbar hemorrhage after asphyxiation. To our knowledge, this case is the first report of this finding in this setting. Physicians should be aware of this phenomenon to guide workup and management. Patients should also be aware of possible health consequences, including vision-threatening sequelae.FIG 1.FIG 2.

  PublisherDOI

• “Reconstruction of Large Full-Thickness Medial Lower Eyelid Defects Using a Medially-Based Tarsoconjunctival Pedicle Flap”

  Plastic & Reconstructive Surgery · 2025-09-03

  articleSenior author

  Reconstruction of large full-thickness medial lower eyelid margin defects often requires centrally-based tarsoconjunctival pedicle flaps from the ipsilateral upper eyelid in combination with anterior lamellar grafting. However, centrally-based flaps may result in temporary obstruction of the visual axis in the affected eye. We present a novel modified surgical technique utilizing a medially-based tarsoconjunctival pedicle flap from the upper eyelid for the reconstruction of large full-thickness medial lower eyelid defects. A tarsoconjunctival flap was mobilized and hinged medially by the conjunctiva from the upper eyelid with rotation into the lower eyelid defect. This surgical technique was utilized in four cases with medial lower eyelid defects involving 60-65% of the eyelid after basal cell carcinoma excision. All cases resulted in successful reconstruction of the defect without graft failure, wound dehiscence, or lagophthalmos. Medially-hinged tarsoconjunctival pedicle flaps are an effective technique for the reconstruction of large full-thickness medial lower eyelid defects. This procedure may be considered especially in patients with similar defects who cannot tolerate ocular occlusion.

  PublisherDOI

• Periostin: a promising biomarker in nonspecific orbital inflammation and orbit-involving IgG4 disease

  Orbit · 2025-06-11

  article

  PURPOSE: To demonstrate crisp, specific immunohistochemistry (IHC) for periostin and document its utility as a biomarker for nonspecific orbital inflammation (NSOI) and immunoglobulin G4-related orbital disease (IgG4-RD). METHODS: A multi-institutional retrospective study of both NSOI and IgG4-RD patients. Demographics, clinical disease location, and severity were recorded. Routine histologic sections of affected NSOI and IgG4-RD tissue and fibrocollagenous control tissue were interrogated with an anti-periostin antibody. RESULTS: Ten NSOI patients had orbital manifestations of variable severity involving the lacrimal gland, extraocular muscle, and diffuse or focal orbital tissue. 12 IgG4-RD disease patients had involvement of the lacrimal gland, multifocal orbital disease, or extra-orbital extension. Periostin IHC showed strong, diffuse positivity restricted to pathological fibrotic zones, sparing inflammatory and epithelial elements. This was observed in both the NSOI and IgG4 cases. CONCLUSION: Periostin is highly expressed in zones of pathologic fibrosis, indicating its potential role in NSOI and IgG4 disease pathogenesis and as a disease biomarker.

  PublisherDOI

• Lower Eyelid Retraction Repair with Dermis Fat Graft

  2025-01-01

  book-chapter
  PublisherDOI

• Single-Stage Management of Recalcitrant Eyelid Festoons

  Plastic & Reconstructive Surgery · 2025-04-29 · 2 citations

  article

  BACKGROUND: Lower eyelid festoons are a challenging aesthetic concern characterized by redundant and edematous folds of lower eyelid skin with minimal orbital fat prolapse. The authors present their surgical approach to managing this condition. METHODS: A retrospective chart review was conducted on patients who underwent surgical repair of lower eyelid festoons at 2 academic centers. Data collected included various measurements, examinations, and satisfaction rates. The procedure involved lower eyelid tightening, an infraorbital curvilinear incision along the base of the lowest festoon, subcutaneous dissection, skin redraping, and closure with a running 7-0 Prolene suture. The orbital septum was kept intact with no orbital fat manipulation. RESULTS: Fifty-four eyes of 27 patients (mean patient age, 69 ± 10 years) were studied, with a mean follow-up of 11 months. The average vertical extent of excised skin was 15 mm. No patient developed lagophthalmos, corneal staining, or eyelid retraction. Minor complications occurred in 2 patients. The recurrence rate was 3.7%. The patient and physician satisfaction rates were high. CONCLUSIONS: Direct infraorbital excision of festoons with concomitant preservation of the inferior tarsal orbicularis oculi muscle, lower eyelid tightening, and septal preservation is a simple and effective treatment option. More than 10 mm of skin can be excised safely without causing lower eyelid retraction. Outcomes are durable at a mean follow-up of nearly 1 year. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

  PublisherDOI

• Impact of unilateral Mueller’s muscle conjunctival resection on contralateral upper eyelid position in patients without preoperative Hering’s effect

  Indian Journal of Ophthalmology · 2025-07-18

  articleOpen accessSenior authorCorresponding

  PURPOSE: To evaluate the effect of unilateral Mueller's muscle conjunctival resection (MMCR) on the contralateral upper eyelid position in patients without preoperative Hering's effect. METHODS: This retrospective study analyzed 33 patients who underwent unilateral MMCR for mild to moderate ptosis at Shiley Eye Institute, University of California, San Diego. Patients with additional procedures or preoperative Hering's effect were excluded. Margin Reflex Distance (MRD1) was measured using Image J software from standardized digital images. Five masked researchers independently measured MRD1, with the average of the middle three values used for analysis. RESULTS: The mean preoperative and postoperative MRD1 of the operated eye were 1.20 mm (SD 0.92) and 3.35 mm (SD 0.83), respectively. For the nonoperated eye, preoperative MRD1 was 3.15 mm (SD 0.85) and postoperative MRD1 was 3.28 mm (SD 0.8). There was a statistically significant improvement in the operated eyelid MRD1 ( P < 0.001) but no statistically significant change in the nonoperated eyelid position ( P = 0.704). One patient (3%) experienced an MRD1 drop >1 mm in the fellow eye. Thirty-two patients (97%) had ≤1 mm difference between operated and nonoperated eyelids postoperatively. Interestingly, 18 patients (54.5%) showed a paradoxical increase in contralateral MRD1 (mean 0.66 mm, range 0.02-2.39 mm). All patients achieved acceptable symmetry without requiring additional procedures. CONCLUSION: MMCR effectively corrects mild to moderate unilateral upper eyelid ptosis with minimal impact on the contralateral eyelid in patients without preoperative Hering's effect. While the procedure resulted in no significant changes to the contralateral eyelid in 97% of cases, the unexpected finding of paradoxical contralateral lid elevation in over half the patients warrants further investigation.

  PublisherDOI

• The utility of orbital imaging in the evaluation of orbital disease

  PLoS ONE · 2024-08-30 · 3 citations

  articleOpen access

  PURPOSE: This study investigates the accuracy of either computerized tomography (CT) or magnetic resonance imaging (MRI) for the evaluation of various orbital diseases. METHODS: We collected 126 CT scans and 65 MRI scans from 144 subjects and asked two radiologists to interpret the images without clinical information. Images included 14 with a clinical diagnosis of orbital infection, 144 with orbital inflammation, and 33 with orbital neoplasm. The inflammatory diseases included thyroid eye disease (TED, n = 69), non-specific orbital inflammation (NSOI, n = 44), IgG4-related disease (IgG4-RD, n = 15), sarcoidosis (Sarcoid, n = 9), granulomatosis with polyangiitis (GPA, n = 5), and Erdheim-Chester disease (ECD, n = 2). RESULTS: The balanced accuracy (BA) for the two radiologists ranged from 0.87 to 0.90 for cellulitis, 0.81 to 0.86 for inflammation, and 0.82 to 0.85 for neoplasm. Radiologists were excellent at recognizing GPA (BA = 0.98 to 0.99) and very good for TED (BA = 0.80 to 0.86). They also did well identifying IgG4-RD (BA = 0.75 to 0.77), but slightly less well for NSOI (BA = 0.69 to 0.75) and poorly for Sarcoid (BA = 0.48 to 0.50). CONCLUSIONS: CT or MRI scanning contributes to the evaluation of patients with orbital disease, but accuracy does varies based depending on the diagnosis. We could not evaluate issues such as determination of disease activity, variability based on the unit used for imaging or the skills beyond those of our two specialized neuroradiologists. Future studies should directly compare the two imaging modalities and assess the utility of imaging to determine disease activity.

  PublisherDOI

• Medical, Environmental, and Social Determinants Associated With Periocular Cutaneous Malignancies in the United States Using the All of Us National Database

  Cureus · 2024-07-31 · 1 citations

  articleOpen access

  Objective: To identify common factors associated with periocular cutaneous malignancies using the National Institutes of Health (NIH) All of Us database. Methodology: In this case-control study, we extracted electronic health records and sociodemographic data for 385 cases of periocular cutaneous malignancies from the All of Us nationwide database. Controls (N = 1540) were matched to the demographic characteristics of the 2020 United States Census. Bivariate analyses and multivariable logistic regression determined variables significantly associated with increased odds of periocular cutaneous malignancies. We analyzed medical, environmental, and social determinants to evaluate which factors were associated with increased odds of periocular cutaneous malignancies. Results: Among the cases, the mean (standard deviation) age was 66.8 (11.2) years at the time of diagnosis. The majority were male (207, 54%) and white (361, 94%). Periocular cutaneous malignancy was significantly more likely among individuals with high sun exposure (odds ratio [OR] 14.79, 95% confidence interval [CI] 3.35-85.73, P = 0.001), those identifying as white race (OR 3.88, 95% CI 1.06-25.33, P = 0.079), and those with higher socioeconomic status, including higher annual income (OR 1.35, 95% CI 1.25-1.46, P &lt; 0.001). Conclusions: This study demonstrates similar risk factors for periocular cutaneous malignancies, echoing prior research that showed increased associations with lighter-pigmented skin and higher socioeconomic status. It also sheds light on the positive impact of physician surveillance and health utilization factors in the early detection and treatment of these malignancies, aspects less explored in prior analyses.

  PublisherOA PDFDOI

Frequent coauthors

• Bobby S. Korn

  Fleet Science Center

  306 shared

• Catherine Y. Liu

  University of California, San Diego

  126 shared

• Audrey C. Ko

  University of California, San Diego

  65 shared

• Michelle Ting

  Fleet Science Center

  52 shared

• Jin Sook Yoon

  Severance Hospital

  49 shared

• Jonathan H. Lin

  VA Palo Alto Health Care System

  41 shared

• Lilangi S. Ediriwickrema

  University of California, Irvine

  35 shared

• Daniel J. Ozzello

  University of California, San Diego

  30 shared

Education

• Ph.D., Ophthalmology

  University of California, San Diego

  1985

• M.D., Medicine

  University of California, San Diego

  1981

• B.S., Biology

  University of California, San Diego

  1977