story byFor most parents, finding a little redness in a child’s eye is more inconvenience than threat. Drs. “Mom-and-Dad” know from experience that it’s probably pink-eye or the accidentally-on-purpose finger poke from a sibling.
But for 3-year-old Grace Campo, it was the tell-tale sign of a condition that is a leading cause of blindness in the United States.
As the wiggling toddler tried to sit still for an examination by Susan Wittenberg, M.D., assistant professor in the Department of Ophthalmology and Visual Science at The University of Texas Medical School at Houston, weeks of unanswered questions were finally answered for Grace’s parents. Their daughter has uveitis (you-vee-itis), a condition that if not caught early can lead to irreversible vision loss.
Uveitis is an inflammation of the uvea, which is the iris, ciliary body, and choroid. Those are the parts of the eye with the highest blood flow. Uveitis can be caused by an infection such as syphilis, trauma to the eye (like an air bag deployment), retinoblastoma (tumor), or an autoimmune response (when the body turns on itself).
In this drawing, the eye is viewed from the top
For Grace, her uveitis was caused by an autoimmune response from the childhood disease, JRA: juvenile rheumatoid arthritis. JRA causes mainly inflamed, swollen joints that are often stiff and painful and affects about 1 in 1,000 children ages 16 and younger.
There are three kinds of JRA. Grace has pauciarticular disease, which means it impacts five joints or less. It is more common in girls than boys. Ophthalmologists diagnose uveitis in about 20 percent of children with pauciarticular disease. It usually strikes before a child reaches age seven, but pauciarticular disease has a higher rate of disappearing on its own in the teenage years.
Grace’s disease began with a limp just two weeks before her third birthday. Parents Greg and Crissy Campo thought their little girl had possibly twisted her ankle. They brought her in to a doctor who said the x-rays were clear and sent them home. For the Campo family that would be one of many misdiagnoses, until one pediatrician asked the question, “Are there any other symptoms besides the limp?”
Grace’s mother, who is a registered nurse, says she noticed her daughter’s eyes were red at times. The pediatrician immediately sent Grace to an ophthalmologist after telling Campo that her daughter may have JRA.
“From that moment on, I looked up everything I could between the pediatrician’s appointment and the ophthalmologist appointment two days later. The Internet gave me a good idea what we might be up against,” Campo says.
“The first line I read included the word ‘devastating’—and I couldn’t see past it,” recalls Greg Campo. “But I knew no matter what, we were going to attack it and beat it.”
The JRA and uveitis diagnoses would take the Campos from their home in Lafayette, LA to the Texas Medical Center and the expertise of Wittenberg. She is the only uveitis expert in the Houston area and one of only two in the state who did specific training in immunosuppression as a course of treatment.
“She was probably the first person who said this is very serious. We were going to be in it for the long haul and it will be a bumpy journey,” says Grace’s father.
The JRA was causing Grace’s immune system to attack her eyes. When Wittenberg saw Grace, her first thought was that Grace hadn’t had the inflammation in her eyes very long.
“Fortunately, she was diagnosed very early,” Wittenberg says. “JRA isn’t usually diagnosed early and they get to us too late. Her vision was still intact. I felt we could get the inflammation in her eyes under control and prevent irreversible damage to her vision.”
Wittenberg immediately prescribed steroid eye drops to reduce the inflammation. She started out taking one drop in each eye hourly. Grace is also on immunosuppression drugs, under the care of Wittenberg and Grace’s rheumatologist.
“The goal is to get Grace down to the lowest amount possible of steroid eye drops, under two to three drops a day, or hopefully eliminate them. The more drops used, the higher the likelihood of her developing glaucoma or cataracts,” Wittenberg explains.
“We don’t know how long this disease will last. Some kids can outgrow JRA in their teenage years; others do not. The important part is preserving Grace’s eyesight. She is doing great and is a thriving 3-year-old. She is now on one steroid eye drop daily and the inflammation is controlled.”
The Campos will continue their long drive to see Wittenberg once a month to monitor Grace’s progress. They urge other parents to see a good eye doctor. “What you learn can be scary—but JRA and uveitis can be tolerated and controlled,” Crissy Campo says. “We feel our daughter’s eyesight is more secured thanks to an early diagnosis. Our little girl is taking it all like a champ.”
UPDATED: 3-28-2007
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Dr. Susan Wittenberg is an assistant professor in the Department of Ophthalmology and Visual Science at the UT Medical School.
Summer Carbon Monoxide Dangers
Generators used to cool off homes in hot summer months can cause death through carbon monoxide (CO) poisoning.
CO is an odorless, colorless gas that can kill or seriously and permanently injure people who inadvertently breathe in the noxious fumes emitted from generators in an enclosed space.
During hurricane season, emergency rooms see a rise in cases of CO poisoning from people bringing generators into their homes to provide power, often for cooling fans as well as cooking.
“During Hurricane Rita, we had a family of five die here in Houston for CO poisoning,” reminds UT Medical School Hyperbaric Medicine expert, Dr.Caroline Fife. “The Center for Disease Control and Prevention tracked deaths from CO poisoning due to combustion engines after Katrina and Rita and there was a dramatic increase.”
“Teak surfing”—holding on to the back of a power boat’s swim platform and being towed—is another danger. The boat’s exhaust pipe is in the face of the swimmer.
People riding in the back of pick-up trucks are at risk, too. Numerous cases have been cited of children poisoned by riding beneath tarpaulins or enclosed “cabs” in the back of the truck. In these cases, the trucks had a leak in the exhaust system or a rear-exiting tail pipe, not a side exit.
Fife also has seen this in boats with malfunctioning exhaust systems. She urges doctors and bystanders to pay special attention when groups of people begin to feel ill at the same time, particularly severe headache and nausea. Children often become symptomatic before adults.
“People associate CO poisoning with cold weather and northern states, but in the South, we see it a lot in summer with people just trying to stay cool,” Fife says.
