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University of Minnesota Health experts collaborate to save child’s eyesight

At first, Victoria Hartung thought the tiny red spot on her two-week-old daughter’s eyelid was just an accidental scratch mark.
When an infantile hemangioma threatened four-month-old Ella’s eyesight, her parents brought her to two University of Minnesota Health specialists.
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At first, Victoria and Andrew Hartung thought the tiny red spot on their two-week-old daughter’s eyelid was just an accidental scratch mark.

Victoria assumed the mark—smaller than the size of a pea—would eventually fade away. Instead, it started growing. When the growth, identified as an infantile hemangioma, began threatening Ella’s vision, the Hartungs turned to two University of Minnesota Health specialists for a rapid response.

“At our eight-week well-child [check-up], our pediatrician told us we’d need to start watching it,” Victoria said. Two months later, the hemangioma was the size of a dime. “If we didn’t have it treated quickly, she would have developed an astigmatism.”

A common condition in an uncommon location
Infantile hemangiomas are relatively common—developing in 6 percent of infants born in the United States, according to Pediatric Dermatologist Ingrid Polcari, MD, who is one of two University of Minnesota Health physicians to treat Ella.

A hemangioma is made up of tiny blood vessels. Ordinarily, they appear within several weeks after birth, and grow in a somewhat predictable fashion during the first year of a child’s life, Polcari said. In most instances, hemangiomas don’t require medical treatment and often recede or disappear entirely as the child grows older.

But in some of cases, the location of a hemangioma can be problematic, according to University of Minnesota Health Pediatric Ophthalmologist Jill Anderson, MD, who also helped treat Ella.

“There are a couple of ways hemangiomas can cause problems for infants, especially if [they are located] on the eyelid,” Anderson said. “The sheer size of them can cause the eyelid to cover the visual axis, and that interferes with a child’s visual development. They can also cause astigmatism which can cause blurring of images and lead to poor visual development.”

Ella was already showing signs of astigmatism in her affected eye when an eye specialist in St. Cloud referred the Hartung family to Anderson, who initially saw Ella at Minnesota Lions Children’s Eye Clinic. After Ella’s first visit, Anderson collaborated with Polcari to develop a treatment plan.

Concerned that the hemangioma would cause eye-related complications, Polcari prescribed the medication propranolol, which affects the walls of the blood vessels in the hemangioma, halts growth and in some cases causes the growth to recede.

Learn more about our pediatric ophthalmology services at University of Minnesota Masonic Children's Hospital.

Saving Ella’s eye
Almost immediately, Ella’s family noticed a difference in the hemangioma above Ella’s eye. In less than a week, the mass went from dark purple to pink in color. Ella remained on the medication for eight months as Polcari incrementally increased her dosage. During each increase, Ella’s care team monitored her blood pressure and heart rate, which can be affected by propranolol.

Learn more about our pediatric dermatology services at University of Minnesota Masonic Children’s Hospital.

By her first birthday, the hemangioma had shrunk in size so that it no longer threatened Ella’s vision. Ella was now at an age where natural growth patterns would likely cause the hemangioma to continue to recede, so Polcari took the toddler off the medication. As predicted, the growth continued to fade.

Victoria calls the medication a “miracle drug,” and is grateful to Polcari and Anderson for helping save her daughter’s eyesight. The Hartungs live outside St. Cloud, Minn. and had to commute to the University of Minnesota Medical Center campus for each of Ella’s clinic visits, but the drive was well worth the care, Victoria said. Fortunately, Ella’s visits to Polcari and Anderson were coordinated by the M Health care team so that Ella was able to see both doctors during each of her visits.

“Every time she had an appointment, I was at ease,” Victoria said. “The doctors enjoyed Ella. They gave her lots of attention and toys, and she just loved it.”

“I’ve always really believed in focusing on the patient, even with really small patients, my attention is on them,” Polcari said. “I think going to the doctor can be fun, and that kids should be allowed to giggle and smile.”

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