UAB Medicine News


A Clear Success: Bennett Butler

Early Detection, Early Action

When he was only three months old, Bennett Butler began experiencing frequent ear infections. He also had a red birthmark around his left eye, and both eyes were watery most of the time.

Bennett’s parents, Kristy and Ryan, assumed that the problems might be related, and that the antibiotics used to treat the ear infections would clear up his eyes. To be safe, the family’s pediatrician referred them to UAB Callahan Eye Hospital’s Thomas Metz, MD, for a routine examination. A few weeks before he was to see Dr. Metz, Bennett had tubes placed in his ears to treat another infection. It was on that day, the Butlers say, that they became even more worried about their son’s eyes.

“I noticed that Monday afternoon that Bennett’s eyes were actually looking cloudier than ever, Kristy says. “Something just didn’t seem right about that. I called Dr. Metz’s office to see if we could come in early, and they saw Bennett right away. That was such a relief.”

Her sense of relief was short-lived. Kristy learned that same afternoon about the seriousness of Bennett’s condition.

“After the examination, Dr. Metz asked me if knew what glaucoma was. I recall thinking, ‘Well, sure, that’s an eye condition that older people might have,’ but he informed me that Bennett had congenital pediatric glaucoma,” Kristy says. “Then he said he wanted to perform surgery as soon as possible. Everything happened so fast. Early that Monday our biggest worry was ear tubes. Then we learn that my infant will be undergoing surgery.”

There was a reason behind the quick decision to have a surgeon at Callahan treat Bennett. Pediatric glaucoma, a rare condition that occurs in roughly one in 10,000 births, can cause blindness within a few months of development. Metz recalls detecting the glaucoma.

“Our first tip-off was that Bennett’s eyes were severely enlarged, and his corneas were cloudy, allowing no clear view of the pupil or iris,” Dr. Metz says. “With the exam, we try to assess a child’s visual attention, how well they focus on objects. An object might not grab their attention because they see very poorly. Also, when we first looked at his eye, we thought the optic nerve had been severely damaged because of its position. The optic nerves showed enlarged cupping, which is the center of the nerve being pushed posteriorly, and that’s consistent with elevated eye pressure.”

This type of glaucoma results from an imbalance in the eye’s trabecular meshwork, a system that controls intraocular pressure (IOP). Damage to fibers of the optic nerve occurs when channels in the meshwork fail to drain the inner eye fluid, resulting in a higher IOP. The condition can be successfully treated with special surgical procedures, but the window of opportunity is narrow.

In Good Hands

To correct Bennett’s IOP, the Callahan team performed a trabeculotomy, which creates an opening in the trabecular meshwork to improve or restore drainage of the aqueous fluid.

The surgery was a success in Bennett’s right eye, but it did not adequately control the pressure in his left eye, which continued showing clouding of the cornea. So Christopher Girkin, MD, Chief Medical Officer for UAB Callahan Eye Hospital, performed a procedure to implant a tube shunt in the left eye, which effectively drains fluid to control IOP.

“When that pressure was relieved, the nerve returned to a normal appearance,” Girkin says. “We got to it soon enough, and that’s always the key with pediatric glaucoma, catching it early.”

That was four years ago. Today, Bennett has 20/20 vision in his right eye and limited vision in the left. He also is being treated for a condition known as amblyopia, commonly known as lazy eye. Metz says that throughout the course of Bennett’s treatments, he inevitably was using his right eye more than his left eye.

“The brain keys into the better eye and processes the better image from that one, and it will begin to ignore information coming from the abnormal eye,” Dr. Metz says. “Amblyopia is a not a matter of a physical change within the eye – it’s how the brain selects information. The left eye began to wander due to the inability of Bennett’s eyes to work in unison.”

Bennett will undergo exams to monitor his IOP indefinitely, and he will continue to need drops and other medication as part of his vision care. His surgeries and treatments have been successful enough that he now leads the life of a typical four-year-old boy. That would be a four-year-old who doesn’t have an “off button,” notes his father, Ryan, with amusement.

“He gets a little plush monkey every visit, and that sort of calms him down or at least distracts him,” Ryan says. “He undergoes some level of anesthesia for the exam. It’s an environment Bennett knows and understands, and the staff always makes certain that this is never a traumatic experience for him. He feels at home and safe here at Callahan now. Every time we bring him in, what’s really impressed us is how well he’s cared for every step of the way, from admission and pre-op to the procedure itself and post op. Nurses, assistants, and doctors have provided a level of care that I haven’t seen anywhere.”

Kristy agrees. “Well, the bottom line is that the doctors here saved Bennett’s vision,” she says. “But we’ve been just as happy about the continuing care. Based on the diagnosis the doctors made and the protocols they established, Bennett will be getting treatment the rest of his life. What matters most is that we know he’s in good hand

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