It was an unremarkable Midwestern summer night. Two brothers were playing outside, watching their grandfather mow the lawn. Because they were too young to help, 3-year-old Luke and his brother did what young boys have always done—they improvised. As Luke’s brother innocently began swiping the grass with a screwdriver, hoping to do his part of the landscaping, an errant swing landed against Luke’s eye.
Closer inspection revealed that Luke’s pupil was no longer round, and so he was ultimately brought to the emergency department at Children’s Mercy Hospital in Kansas City. His examination was an immediate cause for concern. Luke’s eye had ruptured from the impact of the screwdriver.
“At first I thought it was just a piece of dirt on his eye. I had no idea how serious it was,” said his mother. “We were scared about him losing any of his vision, but we were naïve that the only concern was his vision. We didn’t know that he could also lose his eye.”
While the eye is typically durable to blunt impact, it is quite thin in certain areas. Particularly forceful blunt impact is prone to causing breaks, usually referred to as a laceration, in the eye. Once this occurs, tissue that is inside the eye tries to escape through the break, similar to a break in a dam. In Luke’s case, fluid from inside of the eye exited through the break, as did his iris tissue – the colored portion of the eye that forms the pupil. As the iris tissue attempted to exit the rupture, his pupil became distorted. This would need to be repaired, and quickly, if there was going to be a chance for recovery of his vision and to save the eye from having to be removed.
Luke underwent surgery with Dr. Justin Marsh, a pediatric ophthalmologist, to repair his ruptured eye. His iris tissue was pushed carefully back into position. Sutures were placed to repair the break. Fluid was injected into the eye to ensure the leak was sealed. While the repair was complete, Dr. Marsh knew there was still an uphill battle:
“Whenever an individual sustains a laceration of the eye, there are several aspects of rehabilitation. The first is certainly to close the rupture. Afterwards, however, there are numerous concerns, including the risks of vision losing infection, cataract, or glaucoma. In a young child, as in Luke’s case, there is also a high risk for amblyopia (commonly referred to as “lazy eye”), which can cause visual outcomes to be poor even if the repair is done perfectly.”
Because Luke’s rupture was in the visual axis, meaning the break occurred through the area used for vision, even the smallest amounts of scar tissue that developed would cause distortion, similar to looking through a cracked windshield. This distortion can be particularly devastating in young children, who are at risk for amblyopia – a condition where the brain chooses to block out the distorted view, leading to potentially permanent vision loss.
The road ahead for Luke was long. The injury required him to wear glasses and, as expected, he developed amblyopia. The most common treatment for amblyopia is placing an eye patch on the unaffected eye – a difficult task for some young children.
“Approximately 6 months after the surgery, it wasn’t clear if Luke would recover his vision,” said Dr. Marsh. “While his eye had healed well and he had avoided many of the severe consequences of his injury such as cataract or glaucoma, his amblyopia was severe enough that it was possible he might not recover useful vision.”
Fortunately, Luke slowly began to see progress. Through intensive patching therapy and the use of his glasses, Luke’s vision continued to improve. At his most recent visit, Luke had 20/20 vision in his previously injured eye. He also brought an unexpected token with him during his visit. He had brought the baseball from his first ever Grand Slam.
While patching is “still a fight every day,” according to his mother, “we think it is amazing and kind of a miracle how well he has done.” Hopefully Luke has many more Grand Slams in his future.