UCSD - University of California - San Diego

12/02/2024 | Press release | Distributed by Public on 12/02/2024 10:01

Eye Surgeon Helps a Young Boy Blink Again

Published Date

December 02, 2024

Article Content

Carter Padelford, a spirited seven-year-old from Las Vegas, is a boy with dreams as big as his heart. But beneath his cheerful exterior is the daily struggle of living with lamellar ichthyosis, a rare skin condition he has dealt with since birth that leaves his skin dry, constricted and scaly. Most trouble of all, this condition affected his eyelids, causing them to tighten and turn outward, a condition known as ectropion, which prevented proper eye closure.

As a result, he had to sleep with his eyes open.

Shai Bresee, Padelford's mom, is his unwavering advocate. Their everyday life revolves around managing his skin, which requires endless moisturizing creams and meticulous routines. While she tries to shield him from the difficulties of his condition, she can see the toll it takes on him - especially concerning his eyes and quality of sleep.

"It breaks my heart to watch him endure so much pain and struggle just to experience the simple, everyday moments that most take for granted," said Bresee.

Fewer than 5,000 people in the United States have lamellar ichthyosis, according to the National Institutes of Health. It usually appears at birth and leads to thick, plate-like scales that can uncomfortably cover large areas of the body.

The condition can severely impact a child's quality of sleep due to the inability to blink, which leads to dry, unprotected eyes. This exposure not only causes physical discomfort but also heightens anxiety and vulnerability, making it difficult for the child to relax and achieve restful sleep. The resulting fatigue can affect their overall well-being, behavior and social interactions.

Hope began to emerge after being referred to Bobby Korn, MD, professor of ophthalmology and plastic surgery at University of California San Diego School of Medicine and ophthalmologist and oculoplastic surgeon at UC San Diego Health.

The Shiley Eye Institute at UC San Diego Health is the region's only academic eye center, offering leading-edge treatments in all areas of eye care for both children and adults. The UC San Diego Division of Ophthalmic Plastic and Reconstructive Surgery is a globally recognized leader in patient care, education and research. Dedicated experts, including Korn, have pioneered innovative procedures and techniques that have since set the standard in the field.

Padelford before his life-changing surgery that would restore the simple ability to blink. With permission of the Padelford-Bresee family

During their initial consultation, Bresee arrived well informed, armed with printed research and articles. Her determination and love for her son were evident in every effort she made to prepare for what lay ahead.

"Dr. Korn was incredible," Bresee added. "His bedside manner, kindness and confidence were extremely refreshing. He answered all my questions and provided us with all the information we needed to prepare for Carter's surgery."

Korn shared that he felt a profound emotional connection as a parent himself, noting how difficult it is to witness a child fighting with something as fundamental as closing their eyes.

"Rare cases like Carter's are ones we typically encounter only once or twice in our careers as specialists in the field," Korn said. "At UC San Diego Health, we frequently see similar skin conditions in our Level I Trauma Center, particularly ectropion, with patients needing burn care. In those situations, we provide essential support through skin grafts. However, this was our first experience with lamellar ichthyosis, given how uncommon it is."

Korn led the complex procedure to reconstruct Padelford's eyelids, supported by a highly skilled, multidisciplinary team of anesthesiologists, nurses and surgical staff. The surgery, which spanned several hours, required precise planning and expert coordination to ensure the most effective outcome. With a focus on innovation and patient-centered care, the team worked together to address Padelford's unique needs, drawing on their collective expertise in skin grafting, surgical techniques and burn care.

In collaboration with Michael Hsieh, MD, urologist at UC San Diego Health, Korn harvested a skin graft from one part of the body and carefully removed scar tissue around Padelford's eyes. The grafts were then applied to the eyelids, allowing them to close and blink more naturally. This process required a high degree of proficiency, ensuring the skin grafts integrated successfully while maintaining the aesthetic integrity of Padelford's eyelids.

Within moments of the skin grafts being placed and the scar tissue released, Padelford was able to blink for the first time in years - an immediate, life-changing result that highlighted the success of the procedure and the surgical team's remarkable ability.

"Seeing Carter right after surgery was very bittersweet," Bresee said. "It's hard to see your child so vulnerable, but I could see that he was sleeping with his eyes closed. I could only cry at that point. It felt like an instant weight had been lifted, knowing what life would look like after his recovery."

Mother and son spent a few days in San Diego after surgery before heading home to Las Vegas. During that time, Padelford discovered the joy of sleeping comfortably. No longer worried about his eyes being exposed, he could close them and drift into a peaceful slumber, dreaming of adventures. Bresee watched her son transform mentally and physically.

"Carter is most excited about how well he's been sleeping," Bresee said. "It's like he's finally getting real, comfortable rest for the first time in his life. He's also looking forward to spending more time outdoors and playing at the park with his brother."

"I always tell my patients that I'm just the carpenter - I do the work to help restore function, but it's the support from their families, like Carter's mom, who truly build the foundation for their healing," said Korn. "It's exciting to think about how our clinical work and research can lead to better solutions for other patients with lamellar ichthyosis. Carter's story is a reminder of why we do what we do - every child deserves the chance to live a full, joyful life."

"It's exciting to think about how our clinical work and research can lead to better solutions for other patients with lamellar ichthyosis. Carter's story is a reminder of why we do what we do - every child deserves the chance to live a full, joyful life." Bobby Korn, MD, professor of ophthalmology and plastic surgery, UC San Diego School of Medicine and ophthalmologist and oculoplastic surgeon, UC San Diego Health

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