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Timothy J McCulley

Publications and source records attributed to Timothy J McCulley.

At least 19 recordsLinked to original sources
PubMed2006

The effect of decreased visual acuity on clinical color vision testing.

PURPOSE: Evaluate the effect of visual acuity on color vision testing. DESIGN: University based clinical experimental study. METHODS: Right eyes of 12 healthy subjects were fogged with plus lenses to logMAR 1.88 and assessed with D-15 panel, Ishihara, and Hardy-Rand-Rittler (HRR) plates. Subjects were tested at lesser degrees of fogging, 0.1 logMAR intervals. The acuity at which 5% of the population tests abnormally was estimated as follows. The average acuity at which a 10% reduction in correct responses occurred was determined. From this, two standard deviations were subtracted. Examination devices were compared using repeated measures analysis of variance. RESULTS: Color vision testing did not significantly differ from baseline up to logMAR 1.40 (D-15 panel), 1.10 (HRR plates), and 0.72 (Ishihara plates). Testing devices were significantly different (P < .005). CONCLUSIONS: Color vision testing is accurate up to logMAR 1.40 (20/501) with D-15 panel, 1.10 (20/252) with HRR plates, and 0.72 (20/106) with Ishihara plates.

Adult↗
PubMed2005

A comparison of risk factors for postoperative and spontaneous nonarteritic anterior ischemic optic neuropathy.

BACKGROUND: : Whether postoperative non-arteritic ischemic optic neuropathy (NAION) is caused by surgery is unsettled. To provide further evidence on this issue, it is useful to compare the characteristics of patients who develop NAION following intraocular surgery to those who develop NAION spontaneously. METHODS: : In a retrospective review of patients diagnosed with NAION between January 1, 1993 and December 31, 1999, 12 cases of NAION in 11 subjects were identified as occurring within 30 days of cataract extraction or intraocular lens exchange (postoperative NAION group). Using Fisher exact test, the prevalence of NAION risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking, small cup-to-disc ratios) was compared with that of a similarly aged control group of 37 subjects diagnosed with spontaneous NAION (spontaneous NAION group). RESULTS: : Patients with postoperative NAION had a lower prevalence of hypertension than did those with spontaneous NAION (27% versus 68%, P = 0.034) and a lower prevalence of cup-to-disc ratios of less than or equal to 0.2 (55% vs. 94%, P = 0.006). The prevalence of elevated cholesterol, diabetes mellitus, and tobacco use was similar in the two groups. CONCLUSIONS: : The prevalence of hypertension and low cup-to-disc ratios is significantly lower in subjects with NAION following lens-related intraocular surgery than in those with spontaneous NAION, indicating that risk factors for NAION in these settings may be different.

Aged↗
PubMed2005

Dacryocystoceles in the aftermath of Stevens-Johnson syndrome.

Although Stevens-Johnson syndrome has been reported to result in canalicular and nasolacrimal duct obstruction, reports of dacryocystocele formation are lacking. We describe the occurrence and management of bilateral dacryocystoceles related to Stevens-Johnson syndrome. A 45-year-old man, recovered from Stevens-Johnson syndrome, presented with bilateral medial canthal masses and intermittent overlying facial cellulitis. Examination revealed severe keratitis sicca with extensive corneal scarring, cicatricial occlusion of all puncta, and palpable medial canthal masses bilaterally. Computed tomography demonstrated bilateral cystic masses consistent with dacryocystoceles. Bilateral lacrimal sac/cyst excision was attempted, but the left cyst recurred within 6 months after surgery. A dacryocystorhinostomy was then performed, effectively marsupializing the cyst. The puncta were not canalized and stents were not placed. The masses have not recurred with 2 years of follow-up. Dacryocystoceles may arise in the setting of Stevens-Johnson syndrome. Successful management may be achieved with marsupialization to the nasal cavity (dacryocystorhinostomy).

Dacryocystitis↗
PubMed2004

Effect of unilateral blepharoptosis repair on contralateral eyelid position.

PURPOSE: This study evaluates the effect of unilateral blepharoptosis repair on contralateral eyelid position and assesses the relation between preoperative eyelid height interdependence, consistent with Hering law, and surgical outcome. METHODS: The medical records of 54 patients (21 men, 33 women; mean age, 65 years) who underwent external levator advancement for unilateral aponeurotic blepharoptosis were reviewed for preoperative and postoperative margin reflex distance (MRD) of the nonoperated eye. To assess the relation between preoperative Hering dependence (mechanical elevation of the ptotic eyelid causing a decrease in contralateral eyelid height) and postoperative eyelid position, the change in MRD of the nonoperated eye was compared between subjects who on preoperative evaluation did (n=18) and did not (n=36) demonstrate eyelid height interdependence, using the 2-sample t test. RESULTS: After unilateral blepharoptosis repair, the mean (+/- SD) change in contralateral MRD was -0.2 +/- 0.8 mm. There was no significant difference in contralateral MRD change in subjects with and without preoperative Hering dependence (-0.3 +/- 0.8 mm versus -0.2 +/- 0.9 mm, respectively, p=0.78). Seventeen percent (9 of 54) of patients had a contralateral MRD decrease of more than 1 mm. Three patients (5.6%) required contralateral blepharoptosis repair within 1 year of initial surgery. CONCLUSIONS: After levator advancement for unilateral blepharoptosis, roughly 17% of patients will have a decrease in contralateral eyelid height of more than 1 mm, with 5% of patients requiring surgical repair during the first postoperative year. The degree of change in contralateral eyelid height cannot be reliably predicted by preoperative assessment of Hering dependence.

Aged↗
PubMed2003

The effect of optic disk edema on spontaneous venous pulsations.

PURPOSE: We evaluated the effect of optic disk edema on spontaneous venous pulsations (SVP) in patients without elevated intracranial pressure (ICP).Prospective, cross-sectional comparison in an institutional setting. METHODS: Twenty consecutive patients with unilateral optic disk edema due to anterior ischemic optic neuropathy (AION, n = 11) or optic neuritis (n = 9) were evaluated. The proportion of subjects with SVP in both eyes, the involved eye only, the uninvolved eye only, or neither eye was determined. Comparisons were made using the Exact McNemar Test. RESULTS: There was a significant difference in the proportion of uninvolved and involved eyes with SVP (60% [12/20] vs 5% [1/20], P <.005). Spontaneous venous pulsations were present in the uninvolved eye of 12 patients and the nonedematous portion of the optic disk in 1 patient with segmental edema from AION. CONCLUSIONS: Optic disk edema may cause SVP cessation without ICP elevation.

Adult↗
PubMed2003

Nonarteritic anterior ischemic optic neuropathy and surgery of the anterior segment: temporal relationship analysis.

PURPOSE: This study analyzes the temporal relationship between intraocular lens surgery and nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Retrospective cohort study. METHODS: Eighteen cases of NAION in 17 subjects occurring within 1 year after lens-related surgery were identified with a retrospective review of patients diagnosed with NAION. The temporal relationship between NAION onset and surgery was evaluated by using an exact chi-square test of goodness of fit to compare the observed with a uniform distribution, which would be expected if intraocular surgery were not causal. RESULTS: All 18 cases occurred within 6 months of surgery (mean interval, 35 days; range, 1-130 days), which is significantly different from a uniform distribution (P <.001). CONCLUSION: Our data indicate that intraocular lens surgery is associated with the occurrence of NAION.

Aged↗
PubMed2003

Osteogenic sarcoma after orbital radiation rhabdomyosarcoma.

PURPOSE: We describe the occurrence of maxillary and orbital osteogenic sarcoma in a child after treatment of contralateral orbital rhabdomyosarcoma with external beam radiation and chemotherapy. DESIGN: Interventional case report. INTERVENTION: Treatment of a maxillary and orbital rhabdomyosarcoma with surgical resection, systemic chemotherapy, and local radiation. MAIN OUTCOME MEASURES: Occurrence and histology of secondary malignancy after orbital radiation. RESULTS: An eleven year-old male presented for evaluation of left facial swelling, occurring ten years after successful treatment of a right orbital embryonal rhabdomyosarcoma with chemotherapy and 5040 cGY of external beam radiation. Computerized tomography demonstrated a mass involving the left maxillary sinus and orbital floor. Biopsy demonstrated osteogenic sarcoma. Despite attempted total excision with radical maxillectomy, resection margins were found to have microscopic extension of the tumor. Postoperatively he was treated with systemic chemotherapy and local radiation. Eight months postoperatively he remains alive despite local progression. CONCLUSIONS: Osteogenic sarcoma can occur as a secondary malignancy years after the successful treatment of orbital rhabdomyosarcoma with external beam radiation and chemotherapy. After orbital radiation, subjects should undergo routine lifelong examinations.

Child↗
PubMed2003

Proptosis after hair pulling.

We describe proptosis due to a subperiosteal orbital hematoma that originated from a subgaleal bleed caused by hair pulling. A 13-year-old boy presented with a one-week history of progressive proptosis after his older sister pulled his hair during an argument. Computerized tomography showed a subgaleal hematoma and a right superior subperiosteal orbital hematoma. Progressive proptosis and compressive optic neuropathy developed, necessitating surgical evacuation with a favorable outcome.Hair pulling can result in a subgaleal bleed with extension to the orbital subperiosteal space. When managing patients with a subgaleal hematoma, this vision-threatening complication should be considered and treated accordingly.

Adolescent↗
PubMed2003

Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis.

PURPOSE: To evaluate, in patients with acquired good-function blepharoptosis, levator advancement success and surgical failure risk factors. METHODS: This retrospective, case-cohort study was university based. An estimated 828 patients underwent levator advancement for acquired good-function blepharoptosis between January 1, 1990, and December 31, 1999. Seventy-two patients underwent reoperation during the first postoperative year. Of 125 randomly selected patients not undergoing reoperation, 106 met the desired outcome criteria: postoperative margin reflex distance (MRD) >/=2.0 mm and </=4.5 mm in operated eyes and </=1.0 mm asymmetry between eyelids. Mean MRD, levator function, and Hering dependence (ipsilateral eyelid elevation exacerbating contralateral blepharoptosis) prevalence were determined for reoperated and desired-outcome groups and compared by using 2-sample t test and the Fisher exact test, respectively. Multivariate analysis was also performed. RESULTS: Reoperative rates were 8.7% overall, 5.2% of unilateral, and 13% of bilateral cases. Fourteen percent of patients had results outside the desired range but declined reoperation. Univariate analysis revealed significant differences in preoperative characteristics between desired and undercorrected groups: MRD, 1.0 versus 0.32 mm (p=0.001); levator function, 15.4 versus 14.7 mm (p=0.013); and Hering dependence, 50% versus 79% (p=0.005). With multivariate analysis, bilateral blepharoptosis was statistically significant (p=0.014), whereas levator function and Herring dependence were not. No differences were seen between desired and overcorrected groups. CONCLUSIONS: After levator advancement for acquired good-function blepharoptosis, 77% of patients had ideal results and 8.7% underwent reoperation. Patients with bilateral or severe blepharoptosis have increased risk of undercorrection.

Adult↗
PubMed2002

Infraorbital nerve palsy: a complication of laser in situ keratomileusis.

PURPOSE: To report infraorbital nerve dysfunction after laser in situ keratomileusis. DESIGN: Observational case report. METHODS: Neuro-ophthalmologic examination with brain and orbital magnetic resonance imaging (MRI) and orbital computed tomography (CT). RESULTS: During laser in situ keratomileusis, two healthy women, aged 42 and 46 years, experienced acute onset of sharp ipsilateral cheek pain. Both cases occurred during manipulation of the eyelid speculum. Postoperatively, ipsilateral numbness and tingling or pain of the upper cheek was reported, and examination showed decreased sensation in the distribution of the infraorbital nerve. In both cases, brain and orbit MRI and orbit CT were normal. Both patients were managed medically. In one patient, mild symptoms persisted 1 year postoperatively, and in the second patient, moderate discomfort persisted 8 months postoperatively. CONCLUSION: Infraorbital nerve palsy is a potential complication of laser in situ keratomileusis. Symptoms improve but may persist.

Adult↗
PubMed2002

Isolated unilateral neurogenic blepharoptosis secondary to eyelid trauma.

PURPOSE: To describe eyelid trauma as a cause of isolated neurogenic blepharoptosis. DESIGN: Observational case series. METHODS: Three previously healthy patients (two male and one female; aged 29 to 39 years) were evaluated for unilateral blepharoptosis following forceful anterior displacement of the upper eyelid. Two injuries occurred during domestic altercations and one while the patient was playing basketball. RESULTS: All three patients had complete unilateral upper eyelid ptosis with no levator palpebrae superioris function, consistent with loss of innervation. Additional findings included minimal eyelid ecchymosis, eyelid edema, and subconjunctival hemorrhage in two cases. The remainder of the examinations was unremarkable with full ocular motility and no anisocoria. Without treatment, within 2 weeks, all three patients recovered completely with normal symmetric lid height and levator function. CONCLUSIONS: Isolated neurogenic blepharoptosis may result from traumatic anterior upper eyelid displacement. Resolution is likely within 2 weeks.

Blepharoptosis↗
PubMed2002

Cervical carcinoma metastatic to the orbit.

PURPOSE: To describe a case of orbital metastasis from an undifferentiated pelvic tumor with probable cervical origination. METHODS: Case report. Detailed ophthalmologic examination, orbital CT and MRI, and orbital biopsy with histologic and immunohistochemical analysis. RESULTS: A 29-year-old woman with a history of untreated cervical dysplasia was hospitalized with flank pain, hematuria, and abnormal vaginal bleeding. Biopsy of a large mass, protruding from the cervix as a grape-like cluster, had cellular morphology and immunohistochemical staining patterns consistent with cervical cancer. Diplopia in downgaze developed shortly after hospitalization. Ophthalmic examination was notable for mild right lower eyelid fullness, 1.5 mm right relative proptosis, and a deficit in supraduction and infraduction of the right eye. Orbital MRI and CT revealed a 1.2 x 1.6-cm mass immediately inferior and posterior to the right globe without bone involvement. On biopsy, the mass had histology similar to that of the pelvic tumor. On metastatic workup, lesions were found involving the left femoral head, liver, and spinal column, with adjacent lymphadenopathy. Despite treatment with radiation and chemotherapy, the patient died several months later of causes related to the systemic disease. CONCLUSIONS: Orbital metastasis of cancer originating in the cervix, despite its rarity, should be considered when an orbital mass of unknown cause is present.

Adult↗
PubMedDate not supplied

Periocular inflammation after retrobulbar chlorpromazine (thorazine) injection.

PURPOSE: Retrobulbar chlorpromazine injection is a relatively recently described method of pain control in nonseeing eyes. This report illustrates severe sterile inflammation as a potential complication. METHODS: In this university-based, retrospective, small case series, we reviewed the records of 2 female patients and 1 male patient (ages, 13 to 89 years) who developed severe inflammation after retrobulbar chlorpromazine injection. RESULTS: Three patients had development of severe periocular edema after retrobulbar chlorpromazine injection. Two had development of chemosis, limited extraocular motility, proptosis, and incomplete eyelid closure, necessitating temporary tarsorrhaphy. The third patient had development of facial edema involving the ipsilateral eyelids, forehead, and cheek. Strikingly, it extended to the contralateral face. All 3 patients denied discomfort. In each case, swelling was first noted the day after injection and progressed for 1 week. All were treated with topical lubrication and two with temporary tarsorrhaphy. Resolution occurred within 3 weeks in each case. CONCLUSIONS: Severe periocular inflammation can result from retrobulbar chlorpromazine injection and may manifest as chemosis, proptosis, limited ocular motility, and facial swelling that may extend well beyond the eyelids. Awareness of this potential adverse reaction is important both for patient counseling before injection and subsequent treatment. Specifically, a sterile inflammatory response should be differentiated from infection to avoid inappropriate therapy.

Adolescent↗
PubMedDate not supplied

Eyelid retraction and incomplete eyelid closure secondary to human immunodeficiency virus-associated muscle wasting.

Human immunodeficiency virus (HIV)-associated weight loss remains a significant problem, even in the era of highly active antiretroviral therapy. This interventional case report describes eyelid retraction and poor eyelid closure caused by orbicularis atrophy in the setting of HIV-associated muscle wasting. A 65-year-old HIV-infected man sought treatment for chronic ocular irritation. On examination, he was thin with marked temporal wasting. Corneal epithelial defects were present bilaterally. There was 2 mm of superior scleral show in the right eye and trace inferior scleral show bilaterally. With attempted closure, lagophthalmos approached 1 cm in the right eye and was 3 mm in the left eye. The remainder of the examination was unremarkable. Gold weight placement achieved symptomatic improvement with adequate eyelid closure. Biopsy demonstrated fibrous tissue with an absence of identifiable muscle fibers. In the setting of HIV-associated muscle wasting, orbicularis oculi muscle atrophy may result in eyelid retraction, lagophthalmos, and ocular surface disease.

Aged↗
PubMedDate not supplied

Fornix reconstruction with conjunctival inclusion cyst marsupialization in Stevens-Johnson syndrome.

A 17-year-old boy presented with multiple, progressively enlarging cystic masses located at the junction of the lower eyelids and anterior orbit, 1 year after recovery from Stevens-Johnson syndrome. Bilaterally, symblepharon obliterated the inferior fornix and restricted supraduction. All but 1 cyst (which was sent for microscopic evaluation) was marsupialized. Cut edges of the cysts were sutured to adjacent conjunctiva and the epithelial walls were used as fornix lining. Histologically, the wall of the excised cyst consisted of conjunctiva. One year after surgery, the inferior fornices remained substantially deepened with improved ocular motility. This case demonstrated that conjunctival inclusion cysts occurring in the aftermath of Stevens-Johnson syndrome can be effectively managed with marsupialization. The epithelial lining can then be used in fornix reconstruction.

Adolescent↗
PubMedDate not supplied

Effects of sildenafil citrate (Viagra) on choroidal congestion.

This study evaluates the effect of sildenafil on choroidal vascular congestion and its correlation with visual effects. Thirteen healthy subjects were randomized to a sildenafil group (n = 7, 3 M, 4 F), who received 200 mg of sildenafil, and a control (n = 6, 5 F, 1 M) group, who received no drug. Measurements of choroidal thickness with ultrasonography, color vision with Desaturated Panel D-15 Test, and contrast sensitivity with CSV-1000e charts (Vector Vision) were performed at baseline and at 90 and 180 min. Mean choroidal thickness and contrast sensitivity did not change significantly relative to baseline in either group. However, the variance in differences between repeat and baseline measurements of choroidal thickness was significantly higher at 90 min (p = 0.003) in the sildenafil subjects. Color discrimination error scores increased after sildenafil but did not correlate with changes in choroidal thickness. An oral dose of 200 mg of sildenafil caused small inconsistent changes in choroidal thickness, which did not correlate with visual effects.

Adult↗