How This Eye Surgery is Giving Hope to Children, Parents

When Kenley Kebhart was a few months old, her parents noticed something unusual about her eyes.

Her right eye didn’t move the way it should, causing the left eye to compensate—or overcompensate—to make up for the weakness.

“It bothered me as her mom,” Katelyn Kebhart said. “She developed torticollis (a condition where a child’s head tilts to one side), so I knew we needed to get treatment.”

A visit to an ophthalmologist resulted in a referral to Golisano pediatric ophthalmologist Jessica Kovarik, M.D. Dr. Kovarik gave the family what they needed most: a diagnosis and plan to help Kenley.

Dr. Kovarik recognized Kenley’s condition as Duane Syndrome, usually characterized by the inability to move one or sometimes both eyes outward. Less often, the ability to move the eyes inward can be affected. Sometimes, children have both issues.

The condition comes from an abnormal innervation of the lateral rectus muscle—the muscle that moves the eye outward.

The nerve that signals this muscle to move—known as the sixth cranial nerve—does not develop properly, and that means the lateral rectus muscle does not function properly. The reason this happens isn’t really known.

Signs and symptoms of Duane Syndrome include:

• Eye misalignment
• Abnormal head posture to compensate for the eye movement abnormality to avoid double vision
• Poor visual development

Dr. Kovarik offers treatment several options, depending on the age of the child and severity of the syndrome.

“Sometimes patients with Duane Syndrome are observed,” she said. “Other times eye patching or glasses are prescribed. And sometimes eye muscle surgery is done.

“The eye muscle surgery does not restore the function of the abnormal lateral rectus muscle, but it can help improve eye alignment in the straight ahead position and alleviate an abnormal head posture.”

To complete the surgery, Dr. Kovarik made an incision into a membrane, which is then pealed back and the medial rectus muscle – the muscle that moves the eye in – is isolated on a hook. The muscle is then cut away from the wall of the eye and re-attached further back on the eye. This weakens the action of the medial rectus muscle.

Results typically appear immediately after surgery. Dr. Kovarik opted for surgery for Kenley, as well as patching one eye to give the stronger eye appropriate development. In some cases, a second surgery may be necessary. It’s too early to know if Kenley will require more intervention, or if her eyes and head will align as time progresses.

Now 2 ½ years old, Kenley is a typical toddler in every other way. Her vision issues have not affected her ability to learn new things and grow, just like any other child. She got glasses earlier this year and her head tilt is improving.

“I would like for Kenley's eyes to be straight when looking straight ahead without an uncomfortable head posture, and for her to develop equal vision in both eyes,” Dr. Kovarik said.

Katelyn Kebhart is confident Kenley will continue to move forward.

“Once we started looking into her condition, we noticed other people with children in the same situation,” she said. “It’s more common than we thought. We no longer have a concern about her head tile, which is nice.”

Golisano Ophthalmology Services

• Pediatric and adult strabismus (eye muscle disorders of all kinds)
• Amblyopia
• Retinopathy of prematurity
• Nasolacrimal duct obstructions
• Congenital ptosis
• Eye trauma