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It's one of a parent's greatest fears — getting a call from day care that your child has been hurt. That's what happened to Leo Druliner's parents in January.
Leo's mother, Brooke, was at work at Mayo Clinic's Rochester campus, where she performs colorectal cancer research, when the day care facility Leo attended called to tell her he hurt his eye following a fall.
"When I got there, it was apparent that the injury was more extreme," Brooke says. "The material of Leo's left eye appeared to be coming out. I would learn later that this was because his eye had ruptured."
Brooke immediately took her 16-month-old toddler to Mayo Clinic's Department of Emergency Medicine, where Jenny Wang, M.D., an ophthalmologic surgery resident, evaluated Leo. She told Brooke and Brooke's husband, Aaron, that their son would need emergency surgery.
"The white of the eye had a lot of bleeding under the surface. It looked like the eye had a full-thickness laceration," Dr. Wang says. "I could sense how traumatic this was for his parents."
Dr. Wang performed surgery to repair the ruptured globe in Leo's eye alongside Mayo Clinic ophthalmologist and cornea surgeon Sanjay Patel, M.D.
"He was lucky with the location of the injury. It was at the edge of the cornea and toward the front of the eye," Dr. Patel says. "Lacerations toward the back of the eye can be more vision-threatening because they're often associated with retinal detachment."
"Dr. Patel explained everything he saw in the surgery to us and told us he was very pleased with the way he was able to stabilize Leo's eye."Brooke Druliner
Fortunately, Leo's retina was still attached, and doctors stitched the wound closed. Although the surgery was successful, it was uncertain how much vision Leo would recover in the eye.
"Dr. Patel explained everything he saw in the surgery to us and told us he was very pleased with the way he was able to stabilize Leo's eye. He also told us that his eye wouldn't look the same. His pupil would be misshapen because of the loss of iris tissue due to the injury," Brooke says, "And the most difficult news of all was that the chances that Leo would regain his full vision in that eye remained guarded."
Leo's vision was in jeopardy due, in part, to his young age, according to Erick Bothun, M.D., Leo's pediatric ophthalmologist at Mayo Clinic. "Our brain develops vision in the first few years of life, and anything that hinders the function of one eye can disrupt the brain development of the visual acuity and eye alignment," Dr. Bothun says.
Three weeks later, Leo had a second surgery that allowed his care team to better study the eye after it had healed from the first repair. Dr. Bothun removed several of the sutures from the first surgery and confirmed Leo's retina was still attached. But while examining the eye during surgery, Dr. Bothun discovered some of the layers of the retina were torn, which could signal a potential problem with future retinal function.
Dr. Bothun referred the Druliners to Mayo Clinic retina specialist Timothy Olsen, M.D. At the end of February, Dr. Olsen performed a third surgery on Leo's eye. The procedure, called an irridoplasty, changed the shape of the pupil to make it more oblong, rather than keyhole-shaped, as it had been as a result of the injury.
Dr. Olsen also removed the remaining sutures from Leo's eye. It was during this surgery that Dr. Olsen finally was able to see Leo's retina well and confirm that there had been trauma to the back of Leo's eye, close to his optic nerve. But no further surgery would be required.
Retinal detachment, cataracts and glaucoma are among the complications that can result from this type of severe eye injury. But overall, Leo's outlook looks promising, according to Dr. Bothun. "It's a strikingly positive thing for Leo's life that, to this point, that he has not developed more severe complications," Dr. Bothun says. "This is a positive predictor that his chances will be lower in developing them over time."
Once Leo's surgeries were behind him, the focus of his treatment shifted. "After you repair the eye from an injury like this, the goal then becomes restoration of vision development," Dr. Bothun says. "This is a true partnership with the family to maximize their child's visual potential after such a concerning injury."
Dr. Bothun explained that for Leo to have a chance at seeing out of his left eye, Brooke and Aaron would have to help Leo reestablish the brain connection and vision development. To do that, Leo would wear a patch over his uninjured eye, forcing him to see out of the injured one.
"If this left eye isn't made to see, Leo's brain will shut off development of vision on that side," Dr. Bothun explains. "That's why we work on making the brain use the injured eye to give it the potential for which we hope. Once you get the vision established, that's the baseline vision one should enjoy throughout adult life."
"The team of specialists that's been involved in Leo's care has been mind-blowing. I attribute his healing and ability to see out of his injured eye to all of them."Brooke Druliner
"We came home on a Friday and put the patch on the good eye. Within an hour of wearing it, Leo began to see out of his left eye," Brooke says. "I handed him a ball and he said, 'Ball.' We were so overjoyed that he could see. From that first hour, the change in his vision was exponential."
At first, Leo wore the patch whenever he was awake. In just one month, he was seeing so well out of his left eye, he was able to take the patch off in the evenings. Although Leo continues to require ongoing follow-up care, Brooke and Aaron are thrilled with the progress he's made so far.
"His healing has been amazing. Dr. Bothun has been fantastic in terms of guiding us on what we needed to do. He recognized how hard this was for us and really empathized with what we were going through," Brooke says. "The team of specialists that's been involved in Leo's care has been mind-blowing. I attribute his healing and ability to see out of his injured eye to all of them."