Ophthalmologist (eyes)
17 years of experience
Video profile
Accepting new patients
440 E Marshall St
Ste 100
West Chester, PA 19380
212-194-8030
Locations and availability (3)

Education ?

Medical School Score
Albany Medical College (1993)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Patients' Choice 5th Anniversary Award (2012 - 2013)
Patients' Choice Award (2008 - 2013)
Compassionate Doctor Recognition (2012 - 2013)
Associations
American Board of Ophthalmology
American Academy of Ophthalmology
American Association for Pediatric Ophthalmology and Strabismus

Affiliations ?

Dr. Mudgil is affiliated with 9 hospitals.

Hospital Affilations

Score

Rankings

  • Jennersville Regional Hospital
    1015 W Baltimore Pike, West Grove, PA 19390
    • Currently 4 of 4 crosses
    Top 25%
  • Chester County Hospital *
    701 E Marshall St, West Chester, PA 19380
    • Currently 4 of 4 crosses
    Top 25%
  • Brandywine Hospital
    201 Reeceville Rd, Coatesville, PA 19320
    • Currently 3 of 4 crosses
    Top 50%
  • Riddle Memorial Hospital *
  • Christiana Care Health Services
  • Christiana Care Health Services-Wilmington Hospital
  • Wilmington Hospital
  • Wills Eye Hospital
    840 Walnut St, Philadelphia, PA 19107
  • Christiana Hospital
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Mudgil has contributed to 12 publications.
    Title Acantholytic Dermatosis of the Crural Folds with Atp2c1 Mutation is a Possible Variant of Hailey-hailey Disease.
    Date September 2009
    Journal Journal of Cutaneous Medicine and Surgery
    Excerpt

    BACKGROUND: We describe a patient with acantholytic dermatosis of the crural folds (ADCF) that was misdiagnosed and treated as condyloma acuminata for 13 years. After many skin biopsies consistently showed epidermal acantholysis and negative human papillomavirus serotyping excluded condyloma acuminata, a diagnosis of ADCF was considered most likely. OBJECTIVE AND CONCLUSION: Acitretin effectively suppressed the symptomatic hyperkeratosis. Subsequent genetic testing revealed a deletion in the ATP2C1 gene that led us to conclude that this case of ADCF is probably a variant of familial benign chronic pemphigus (Hailey-Hailey disease).

    Title Poststeroid Panniculitis.
    Date March 2008
    Journal Journal of Cutaneous Pathology
    Excerpt

    Poststeroid panniculitis (PSP) is a rare complication of systemic corticosteroid therapy. Clinically, erythematous nodules and indurated plaques develop on the cheeks of children within days or weeks following rapid systemic steroid tapering or cessation. The clinical differential diagnosis of childhood cheek erythema is broad. However, PSP can be identified by clinical history and, if necessary, with a biopsy. Histologically, PSP presents as lobular panniculitis with a mixed inflammatory infiltrates without vasculitis. Needle-shaped clefts within adipocytes are characteristic. The histological differential diagnosis of adipocytes containing needle-shaped crystals is limited. We describe a case of poststeroid panniculitis and discuss the clinicopathological features and pertinent differential diagnoses.

    Title Toxic Epidermal Necrolysis.
    Date February 2007
    Journal Journal of the American Academy of Dermatology
    Excerpt

    Toxic epidermal necrolysis (TEN) is an unpredictable, life-threatening drug reaction associated with a 30% mortality. Massive keratinocyte apoptosis is the hallmark of TEN. Cytotoxic T lymphocytes appear to be the main effector cells and there is experimental evidence for involvement of both the Fas-Fas ligand and perforin/granzyme pathways. Optimal treatment for these patients remains to be clarified. Discontinuation of the offending drug and prompt referral to a burn unit are generally agreed upon steps. Beyond that, however, considerable controversy exists. Evidence both pro and con exists for the use of IVIG, systemic corticosteroid, and other measures. There is also evidence suggesting that combination therapies may be of value. All the clinical data, however, is anecdotal or based on observational or retrospective studies. Definitive answers are not yet available. Given the rarity of TEN and the large number of patients required for a study to be statistically meaningful, placebo controlled trials are logistically difficult to accomplish. The absence of an animal model further hampers research into this condition. This article reviews recent data concerning clinical presentation, pathogenesis and treatment of TEN. LEARNING OBJECTIVES: At the conclusion of this learning activity, participants should have acquired a more comprehensive knowledge of our current understanding of the classification, clinical presentation, etiology, pathophysiology, prognosis, and treatment of TEN.

    Title Design of and Normative Data for a New Computer Based Test of Ocular Torsion.
    Date November 2004
    Journal Binocular Vision & Strabismus Quarterly
    Excerpt

    PURPOSE: To evaluate a new clinically practical and dynamic test for quantifying torsional binocular eye alignment changes which may occur in the change from monocular to binocular viewing conditions. METHODS: The test was developed using a computer with Lotus Freelance Software, binoculars with prisms and colored filters. The subject looks through binoculars at the computer screen two meters away. For monocular vision, six concentric blue circles, a blue horizontal line and a tilted red line were displayed on the screen. For binocular vision, white circles replaced blue circles. The subject was asked to orient the lines parallel to each other. The difference in tilt (degrees) between the subjective parallel and fixed horizontal position is the torsional alignment of the eye. The time to administer the test was approximately two minutes. RESULTS: In 70 Normal subjects, average age 16 years, the mean degree of cyclodeviation tilt in the right eye was 0.6 degrees for monocular viewing conditions and 0.7 degrees for binocular viewing conditions, with a standard deviation of approximately one degree. There was no "statistically significant" difference between monocular and binocular viewing. CONCLUSION: This computer based test is a simple, computerized, non-invasive test that has a potential for use in the diagnosis of cyclovertical strabismus. Currently, there is no commercially available test for this purpose.

    Title Primary Position and Listing's Law in Acquired and Congenital Trochlear Nerve Palsy.
    Date October 2003
    Journal Investigative Ophthalmology & Visual Science
    Excerpt

    PURPOSE. In ocular kinematics, the primary position (PP) of the eye is defined by the position from which movements do not induce ocular rotations around the line of sight (Helmholtz). PP is mathematically linked to the orientation of Listing's plane. This study was conducted to determine whether PP is affected differently in patients with clinically diagnosed congenital (conTNP) and acquired (acqTNP) trochlear nerve palsy. METHODS. Patients with unilateral conTNP (n = 25) and acqTNP (n = 9) performed a modified Hess screen test. Three-dimensional eye positions were recorded with dual search coils. RESULTS. PP in eyes with acqTNP was significantly more temporal (mean: 21.2 degrees ) than in eyes with conTNP (6.8 degrees ) or healthy eyes (7.2 degrees ). In the pooled data of all patients, the horizontal location of PP significantly correlated with vertical noncomitance with the paretic eye in adduction (R = 0.59). Using a computer model, PP in acqTNP could be reproduced by a neural lesion of the superior oblique (SO) muscle. An additional simulated overaction of the inferior oblique (IO) muscle moved PP back to normal, as in conTNP. Lengthening the SO and shortening the IO muscles could also simulate PP in conTNP. CONCLUSIONS. The temporal displacement of PP in acqTNP is a direct consequence of the reduced force of the SO muscle. The reversal of this temporal displacement of PP, which occurs in some patients with conTNP, can be explained by a secondary overaction of the IO muscle. Alternatively, length changes in the SO and IO muscles, or other anatomic anomalies within the orbit, without a neural lesion, may also explain the difference in location of PP between conTNP and acqTNP.

    Title Ultraviolet B Irradiation Induces Expansion of Intraepithelial Tumor Cells in a Tissue Model of Early Cancer Progression.
    Date August 2003
    Journal The Journal of Investigative Dermatology
    Excerpt

    Ultraviolet B irradiation is thought to enable skin cancer progression as clones of genetically damaged keratinocytes escape apoptosis and expand at the expense of adjacent normal cells. Mechanisms through which potentially malignant cells in human skin undergo clonal expansion, however, are not well understood. The goal of this study was to characterize the role of ultraviolet B irradiation on the intraepithelial expansion of early stage human tumor cells in organotypic skin cultures. To accomplish this, we have studied the effect of ultraviolet B irradiation on organotypic cultures that were fabricated by mixing normal human keratinocytes with beta-galactosidase-marked, intraepithelial tumor cells (HaCaT-ras, clone II-4), which bear mutations in both p53 alleles and harbor an activated H-ras oncogene. We found that when organotypic mixtures were exposed to an ultraviolet B dose of 50 mJ per cm2, intraepithelial tumor cells underwent a significant degree of proliferative expansion compared to nonirradiated cultures. To understand this response, organotypic cultures of nor-mal keratinocytes were exposed to ultraviolet B and showed a dose-dependent increase in numbers of sunburn cells and TUNEL-positive cells although their proliferation was suppressed. In contrast, neither the apoptotic nor the proliferative response of II-4 cells was altered by ultraviolet B in organotypic cultures. The differential response of these cell types suggested that II-4 cells were resistant to ultraviolet-B-induced alterations, which allowed these intraepithelial tumor cells to gain a selective growth and survival advantage relative to neighboring normal cells. These findings demonstrate that ultraviolet B exposure can induce the intraepithelial expansion of apoptosis-resistant, p53-mutant, and ras-activated keratinocytes, suggesting that this agent can act to promote the early stages of epithelial carcinogenesis.

    Title Motor Mechanisms of Vertical Fusion in Individuals with Superior Oblique Paresis.
    Date September 2002
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    PURPOSE: We wanted to determine the mechanisms of motor vertical fusion in patients with superior oblique paresis and to correlate these mechanisms with surgical outcomes. METHODS: Ten patients with superior oblique paresis underwent 3-axis, bilateral, scleral search coil eye movement recordings. Eye movements associated with fusion were analyzed. RESULTS: Six patients had decompensated congenital superior oblique paresis and 4 had acquired superior oblique paresis. All patients with acquired superior oblique paresis relied predominantly on the vertical rectus muscles for motor fusion. Patients with congenital superior oblique paresis were less uniform in their mechanisms for motor fusion: 2 patients used predominantly the oblique muscles, 2 patients used predominantly the vertical recti, and 2 patients used predominantly the superior oblique in the hyperdeviated eye and the superior rectus in the hypodeviated eye. The last 2 patients developed the largest changes in torsional eye alignment relative to changes in vertical eye alignment and were the only patients to develop symptomatic surgical overcorrections. CONCLUSION: There are 3 different mechanisms for vertical fusion in individuals with superior oblique paresis, with the predominant mechanism being the vertical recti. A subset of patients with superior oblique paresis uses predominantly the superior oblique muscle in the hyperdeviated paretic eye and the superior rectus muscle in the fellow eye for fusion. This results in intorsion of both eyes, causing a large change in torsional alignment. The consequent cyclodisparity, in addition to the existing vertical deviation, may make fusion difficult. The differing patterns of vertical fusional vergence may have implications for surgical treatment.

    Title Correlation of Pupil Size to Iris Color in Children.
    Date August 2002
    Journal Journal of Refractive Surgery (thorofare, N.j. : 1995)
    Title Childhood Optic Atrophy.
    Date August 2001
    Journal Clinical & Experimental Ophthalmology
    Excerpt

    PURPOSE: To determine the causes, and relative incidence of the common causes, of optic nerve atrophy in children under 10 years old and to compare prevalent aetiologies with those given in previous studies. METHODS: The Wilmer Information System database was searched to identify all children, diagnosed between 1987 and 1997 with optic atrophy, who were under 10 years old at diagnosis. The medical records of these children were reviewed retrospectively RESULTS: A total of 272 children were identified, Complications from premature birth were the most frequent aetiology of optic atrophy (n = 44, 16%); 68% of these premature infants having a history of intraventricular haemorrhage. Tumour was the second most common aetiology (n = 40, 15%). The most frequent tumour was pilocytic astrocytoma (50%), followed by craniopharyngioma (17%). Hydrocephalus, unrelated to tumour, was the third most common aetiology (n = 26, 10%). In 114 cases (42%), the cause of optic atrophy became manifest in the perinatal period and/or could be attributed to adverse events in utero. A cause was not determined in 4% of cases. CONCLUSIONS: In the last decade, prematurity and hydrocephalus appear to have become important causes of optic atrophy in childhood. This trend is probably the result of improved survival of infants with extremely low birth weight.

    Title Relative Efficacy of the Argon Green, Argon Blue-green, and Krypton Red Lasers for 10-0 Nylon Subconjunctival Laser Suture Lysis.
    Date August 2000
    Journal Ophthalmic Surgery and Lasers
    Excerpt

    BACKGROUND AND OBJECTIVE: To determine the optimal wavelength for subconjunctival laser suture lysis. MATERIALS AND METHODS: 130 black monofilament 10-0 nylon sutures were sewn subconjunctivally into the bare sclera of enucleated rabbit globes. The lowest energy levels facilitating laser suture lysis were determined for the argon green (514.5 NM), argon blue-green (488.0 NM, 514.5 NM), and krypton red (647.1 NM) wavelengths. In addition, absorption spectroscopy was performed on the suture material and conjunctiva using the Perkin Elmer W/VIS Lambda 2 spectrometer. RESULTS: Krypton red produced the fewest buttonhole defects, and it was also the most efficient energy source for suture lysis (P = 0.0001) under nontenectomized conjunctiva. Absorbance spectra studies revealed peak absorbance at 628 NM for the 10-0 nylon suture material. CONCLUSIONS: Based on animal and absorption spectroscopy studies, krypton red may be a safer and more efficient wavelength for subconjunctival laser suture lysis.

    Title Ophthalmologic Outcome After Third Cranial Nerve Palsy or Paresis in Childhood.
    Date March 1999
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    PURPOSE: The purpose of this study was to evaluate the causes and ophthalmologic outcome of oculomotor nerve palsy or paresis in children younger than 8 years of age. METHODS: Patients evaluated between 1985 and 1997 were retrospectively reviewed. Data analyzed included vision, residual strabismus after surgery, aberrant reinnervation, binocular function, and anisometropia. Long-term outcome was assessed in patients followed-up longer than 6 months. RESULTS: Forty-one patients were identified. The most frequent causes were congenital (39%), traumatic (37%), and neoplastic (17%). Visual acuities were reduced in 71% of patients at the time of the initial visit. Long-term outcome could be assessed in 20 of the 41 patients (49%), with a mean follow-up of 3.6 years (range, 0.5 to 13 years). Visual acuities were reduced because of amblyopia in 35% and nonamblyopic factors in 25% of patients in the long-term outcome group at last follow-up. The best response to amblyopia therapy was in the congenital group, in which all patients improved to normal visual acuity. Strabismus surgery was performed on 8 of 20 children (40%) followed-up, none of whom demonstrated measurable stereopsis after operation despite improved alignment. Aberrant reinnervation was present in 9 of 20 patients (45%). Only 3 patients fully recovered from their oculomotor nerve injuries, and these were the only patients to regain measurable stereopsis. The causes in those 3 patients were congenital, traumatic, and neoplastic. CONCLUSIONS: Oculomotor nerve palsy/paresis is associated with poor visual and sensorimotor outcome in children younger than 8 years of age. The best ophthalmologic outcome was in the resolved cases (3 of 20; 15%). Amblyopia therapy was most effective with congenital causes, but treatment results were poor with other causes. Young children with posttraumatic and postneoplastic oculomotor nerve injuries demonstrated the worst ophthalmologic outcomes.

    Title Varix of the Angular Vein Manifesting As a Medial Canthal Mass.
    Date September 1993
    Journal American Journal of Ophthalmology

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