Trauma often strikes quickly, with no warning, and with the ability to transform everyday activities into living nightmares.

With the only designated Level 1 eye trauma center in the region, Wilmer Eye Institute is singularly positioned to care for people who experience eye trauma both during the acute phase of their injury and, through Wilmer’s numerous specialty clinics, for the duration of the follow-up care that is often needed. Here, we share the stories of two patients who received care at Wilmer for vision-threatening injuries.

Mack’s Story

On July 5, 2022, 24-year-old Mackenzie (“Mack”) Northrop, a heavy-duty diesel mechanic, was trying to dislodge a stuck metal sprocket on an excavator. He pounded it a couple of times with a hammer, but it wouldn’t budge. He hit it again, and when he did so, a chunk of metal flew into his eye.

Northrop was stunned. When he closed his other eye, all he could see was blood. His boss rushed him to the nearby emergency room on Maryland’s Eastern Shore.

At the hospital, doctors gave Northrop pain medication and planned to airlift him across the bay to the Wilmer Eye Trauma Center. When thunderstorms in the area made it too dangerous to fly, he traveled instead by ambulance to Wilmer with his wife, parents and boss following behind.

Through his injured eye, Northrop could see only light and shapes — hand motion, but not fingers. A CT scan revealed that the 6-millimeter piece of metal had created an opening through the center of his eye — known as an open globe injury — destroying the lens and lodging in the retina, where it caused hemorrhage and a tear. The object rested adjacent to the optic nerve, which is responsible for transmitting visual information from the eye to the brain.

Northrop needed surgery urgently, but even with the surgery, the prognosis for vision in the eye was limited.

In the operating room, assistant chief of service Narine Viruni, M.D., and retina fellow Noam Rudnick, M.D., Ph.D., closed the ruptured globe, removed the damaged lens, retrieved the piece of metal and repaired the retina. If there was a chance of restoring his vision, Northrop would need a second surgery, to implant an artificial lens to replace the one that had been destroyed. But first, he needed to heal.

Six months after the initial surgery, cornea specialist Michael Sulewski, M.D., and Wilmer resident Leangelo Hall, M.D., operated again, this time implanting an artificial lens. They also placed sutures in his pupil, which had been misshapen by the injury, to make it round once again. The following day, Northrop and his wife, Christine, returned to Wilmer where the bandages would be removed and they would learn whether he would be able to see out of the eye again.

“It was definitely a big improvement,” says Northrop, who attained 20/30 vision in the eye. “Everything is slightly blurry, a little distorted, but if I went blind in my good eye, I’d still be able to live a high quality of life,” he says. The following week, he was able to return to work.

Mackenzie ("Mack") Northrop, right, with son Brayden after Northrop's second surgery

Northrop reflects on the accident that nearly cost him his eye. “I learned the hard way about wearing safety glasses. When I see people weed whacking on the side of the road with no safety glasses on, it makes me cringe,” he says.

He’s grateful to the doctors, nurses and staff at Wilmer who restored his sight. “I can’t thank those people enough who took care of me. Everybody was super knowledgeable, super nice, super understanding. It was definitely top-notch care,” he says.

John’s Story

John Louderback was in his backyard doing something that millions of people do regularly: He was weed whacking, when a rock flew up and hit him in the eye.

A local ophthalmologist prescribed a steroid medication, but two days later, Louderback was in significant pain. The ophthalmologist referred him to a corneal specialist in nearby Frederick, who suspected an infection. He swabbed the eye and sent the swab off for analysis. “You’ve got to get to Wilmer,” he told Louderback.

At Wilmer’s Eye Trauma Center, Louderback was evaluated by on-call resident Sidra Zafar, M.D. Louderback had suffered a corneal abrasion when the rock hit his eye, but he also had a serious fungal infection, which led to the development of a vision-threatening ulcer.

“Fungus is everywhere, so if you get an abrasion, get some bad luck — especially some vegetative matter, something from the garden, going up and hitting your eye — you can get an infection,” says Michael Sulewski, M.D., who led Louderback’s care team.

Over the next eight months, Louderback had some 40 follow-up visits at Wilmer where, in addition to Sulewski and Zafar, his care team included resident Loka Thangamathesvaran, M.D., and trauma center director Fasika Woreta, M.D., M.P.H., the Eugene de Juan, M.D. Professor of Ophthalmic Education. Louderback created a spreadsheet to record the length and width of the ulcer at each visit so he could see that he was in fact making progress — that the ulcer was closing.

While fungal infections are notoriously challenging to eliminate, the team was able to eventually stop Louderback’s infection, and the ulcer healed. However, months of inflammation caused scarring over the pupil. It also caused a cataract to form. The question now was whether the damage to the eye was significant enough to require a corneal transplant, or whether the cornea could be salvaged.

Sulewski operated to remove the cataract and break up the scar around the pupil. Afterward, he referred Louderback to Lee Guo, O.D., to be fitted with a specialized contact lens that would help smooth over any irregularities on the cornea’s surface. Ultimately, however, the large, irregularly shaped corneal scar impeded Louderback’s vision such that even the specialized lens couldn’t compensate, and he elected to have Sulewski perform a full cornea transplant.

Lee Guo and John Louderback

Louderback can’t say enough about the people who cared for him at Wilmer, including Sulewski, whom he calls magnificent. “Dr. Sulewski explained everything so well. He really took the time,” Louderback says. He can’t get over the fact that Thangamathesvaran gave him her cellphone number. But Thangamathesvaran says, “Every patient I treat is like a family member. If it was my mom or dad, I would want that level of accessibility for them.”

The Wilmer Eye Institute's Eye Trauma Center

The Wilmer Eye Institute's Eye Trauma Center is the sole, designated facility in Maryland specializing in the diagnosis, treatment and long-term management of ocular trauma. At the center, Wilmer Eye Institute faculty, staff and trainees collaborate with Johns Hopkins Hospital adult and pediatric emergency departments and care teams to meet the comprehensive care needs of patients in Maryland, the District of Columbia and seven surrounding states.

Each year Wilmer is consulted to respond to around 2,000 emergency department patients with eye concerns, spanning all age groups, from neonatal, pediatric and adolescent to adult and geriatric. To learn more about the Eye Trauma Center at Wilmer Eye Institute, visit: www.hopkinsmedicine.org/wilmer/services/trauma-center

            Fasika Woreta

Fasika Woreta, M.D., M.P.H., the Eugene de Juan, M.D. Professor of Ophthalmic Education, is director of the Wilmer Eye Trauma Center, as well as president of the board of directors of the American Society of Ophthalmic Trauma, a collective of ophthalmologist-leaders across the U.S. that is highly engaged in eye trauma education, policy-setting, academic collaboration and next-generation training. “I’m so proud of our incredible team of residents, fellows, faculty and nurses who work hard every day to care for patients with a wide range of traumatic eye injuries,” says Woreta.