Scott Hanselman

Root Cause Analysis for Toddlers and Medical Eyeball Tweezers

April 19, '12 Comments [51] Posted in Musings
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Eye picture from BMJThis has been a very stressful week. Our four year old had a piece of metal in his cornea. Twice. That's two different pieces over multiple days in the same eye. In one week. He's great now, no lasting damage and no vision trouble. That's not his eye pictured at right.

He was having trouble sleeping and was complaining about his eye hurting. He's had eyelashes in his eye before so we check it out, didn't see much, and flushed with saline eye drops anyway. He wouldn't fall asleep and kept waking in a start. About 1 in the morning it was clear that he was in some considerable pain and wasn't going to sleep. We looked again with a bright flashlight. Turns out that little kids not only don't like standing still but they don't like staying still with a bright light in their eyeball. We did get a hint of something, right on the surface of the eye next to the pupil. I couldn't get it out with the edge of a tissue so we headed to the emergency room.

The very kind doctor at the ER took a look with a slit lamp and exclaimed: "It's something metal!" She numbed the eye and tried to remove it but quickly decided it was out of her expertise and call the on call ophthalmologist. They woke up the eye surgeon and brought him in to check it out. We found ourselves with a tired toddler and a tired (but kind) eye doctor after 2am trying to get this metal out of his little eye with some kind of special set of medical eyeball tweezers. Again, may I mention that while my son is and was a trooper, no one likes to hear "eyeball" and "tweezers" in the same sentence, especially when combined into one super scary term: "medical eyeball tweezers."

His patience exhausted, my baby fell asleep crying. The doctor said I got all the metal and 80% of the rust.

Rust? Yes, rust. Rust that looks roughly like this.

Rust rings in your eyeball

Iron rusts in the eye very quickly and creates a rust ring (iron oxide). That ring often needs to be removed as well usually with the equivalent of an "eyeball Dremel tool," like this one below.

Eye Dremel picture from @mycastleproject

We were told to return the following day to get the remainder of the rust. We went home, tired but feeling reasonably comfortable that this strange thing was a fluke and that everything would be cool. The following day an attempt was made to get the last bit of rust but bless him, he wouldn't stay still so the we and doctor decided against further trauma. The chances are that the very small bit of rust will just dissipate. If not, we'd deal with it later when he's older.

My son went to school and the next day came home complaining about his eye. The doctor had said it would feel like there was something in his eye (even though it had been removed) and that this was common. However, he couldn't sleep and insisted something was wrong. We have learned to listen to little people, even and especially at 2am.

There was something new in his eye - the same eye.

I could only assume that the doctor didn't get everything the last time. Off to the ER again (don't mess with eyes) but this time they were not wiling to wake up the eye doctor. We saw him a few hours later first thing in the morning. I asked if it was the same piece and he said, "no, it's the same eye but a different location. You can tell because the original rust ring is a marker."

He was shocked to say the least. "In 30 years I've never seen someone get something in their eye twice. Not even in people who grind metal for a living."

He tried to get it out but my baby wasn't having it. The decision was made (and not lightly) to use general anesthesia to perform the eye surgery procedure and get it out. This kind of thing requires one stays completely still and you just can't ask a 4 year old to do that.

I just couldn't get my head around the idea that this was a new piece of metal. What if a third one showed up? What was he doing or what was he around to cause this? Was he banging metal cars together? Was it shavings off his metal bed? Maybe sandbox sand being thrown in the air? Something from our new car?

My wife and I became obsessed with "root causing." I spent a day moving through my son's life, touching everything. Toys, beds, toothbrushes, car seats, furniture. No luck.

We were at the hospital yesterday and he was put under and had the procedure done. The doctor said it was successful and not only did he get th second piece of metal out but also cleaned up the now two rust rings.

We asked again, "How do we keep this from happening again?"

The doctor said, "You've got to find the cause or it very well could reoccur. The thing is..." he reiterated, "I've never seen this, even in metal grinders or folks in manufacturing."

We took baby home with a healthy dose of paranoia. Should he wear glasses until this is figured out? Then we had an idea. Where does a 4 year old come in contact with grinding metal. Why our son and not the other kids?

Wait. Metal grinders. Where does my son go where metal grinds together?

The playground swing. Specifically the tire swing. I've seen him spin on the swing for hours with his head parallel to the ground, eyes wide open looking at the clouds.

I went to the playground, found the swing and touched the metal ball where the hip joint fits into the bearings. My finger came out covered in what looked like glitter. Metal shavings. The tire swing joint was dry and cold - effectively a metal grinder rotating directly over his eyes.

There's nothing more satisfying than The Answer.

Tire Swing photo by Craigie3000. Used under CC.

I spoke to the principal of the school and he made some calls and actually spoke to the designer of the playground product who hooked him up with the designer of the swivel. They are swapping the Tire Swing Hanger for a Heavy Duty hanger that includes a rubber boot to cover the joint.Tire SwivelHeavy Duty Tire Swivel

This was a clear and satisfying end to a very painful experience for the little guy. I'm just happy we figured it out but I think we are going to be paranoid about eyeballs for a the foreseeable future.

About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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Thursday, April 19, 2012 10:31:32 PM UTC
Hi!

Real glad to hear that you little boy is fine and healthy. I have a boy that age too, and these kinds of things always stress you out during, and make you paranoid after. Be well, you and your whole family.
Schmulik Raskin
Thursday, April 19, 2012 10:31:45 PM UTC
Wow, even as an adult that sounds like a scary (not to mention frustrating) situation. It must feel amazing to know that you debugged the swing.
Thursday, April 19, 2012 10:32:11 PM UTC
Wow! Glad to hear everything is OK.
Thursday, April 19, 2012 10:40:00 PM UTC
I'm surprised you didn't have to set more breakpoints to find the cause of that issue. Good sleuthing.

Time for a class action lawsuit... *sigh*
Bryant
Thursday, April 19, 2012 10:40:02 PM UTC
Great troubleshooting! I've had the same thing happen to me and yeah it's not pleasant.
Davin Studer
Thursday, April 19, 2012 10:40:07 PM UTC
That's absolutely amazing. Good detective work you did there, Scott!
Thursday, April 19, 2012 11:06:24 PM UTC
Trying to protect children is so darn hard.
DaveWill
Thursday, April 19, 2012 11:07:45 PM UTC
I know you had difficult time. Glad to know things went well and sorted out.

Tun
Tun Hein
Thursday, April 19, 2012 11:11:48 PM UTC
Yikes! "medical eyeball tweezers" is definitely not something anyone wants to hear regarding themselves, much less their child.

I'm glad you were able to figure out what it was and that all is well. Well done with the follow through to find the root cause and make sure your kid is safe. It had to be quite a disturbing thing to go through *twice*.
Thursday, April 19, 2012 11:21:59 PM UTC
I love a good detective story.
Thursday, April 19, 2012 11:36:22 PM UTC
Glad to hear everything is ok but... no magnetic tweezers to get the metal out quickly and .. you know.. with higher degrees of certainty?
Thursday, April 19, 2012 11:44:50 PM UTC
Wow. Glad to hear he's okay. Great detective work, and it's great that the school is fixing the swing.
Lance Fisher
Thursday, April 19, 2012 11:49:50 PM UTC
Proving once again that you sir are a boss!
Friday, April 20, 2012 12:18:25 AM UTC
Glad your kid is ok. How about pushing for a product recall on those metal swivels?
Friday, April 20, 2012 12:24:33 AM UTC
@Francesco,

I don't think you would want the metal tearing across the eyeball, especially if it were sharp. Also, if he didn't know there was another one, he could accidentally pull it through the eye!!!
Friday, April 20, 2012 12:24:49 AM UTC
Great job, Scott, and thanks for sharing.
Friday, April 20, 2012 12:45:02 AM UTC
What a great story and great outcome, I am glad that you found out the cause of it, this will help prevent other kids and their parents from experiencing the same thing.
Friday, April 20, 2012 2:11:48 AM UTC
Having had corneal transplants under local anesthetic when I was teenager, I can completely relate to the trauma. I cannot imagine experiencing that at age 4. Hug your little one and take a day off. One cannot underestimate the value of eyesight.
Friday, April 20, 2012 2:24:56 AM UTC
I got a speck of something in my eye while deployed overseas. It was one of the most frustrating things to ever happen to me. It sounds so minuscule but I couldn't see with one of my eyes because it hurt so much to keep that eye open.

Anyway, I was lucky enough to have a special forces unit attached to my unit at the same time. Their medic was totally awesome. He poured a solution in my eye and shone a blacklight and found that there was something in there because there were scratches all over my cornea. He was able to find the piece of grit or sand and swiped it out with a q-tip.

Glad to hear how things turned out with your kid. I had the House M.D. theme song going on in my head when I read Act III... :D
Friday, April 20, 2012 3:18:18 AM UTC
Thanks for sharing! And hope it will never happen again.
God bless.
teoman
Friday, April 20, 2012 3:25:29 AM UTC
Glad your kid is doing ok. Great analytical reasoning on your part to find out the root cause of the problem and fix it. Your Sir are true developer.
britto
Friday, April 20, 2012 3:59:17 AM UTC
Great to hear that you got this figured out! Speaking as a parent of young kids, thanks for sharing the information.

Were you able to follow up with the doctor and let her know the root cause?
Friday, April 20, 2012 4:15:02 AM UTC
Wow! Nice detective work!
Friday, April 20, 2012 6:02:27 AM UTC
I love happy endings. I'm so happy you found the cause.

My solution would've been rope - from the start.
Friday, April 20, 2012 6:53:52 AM UTC
Nice example of deduction there. Glad that everything worked out.
Friday, April 20, 2012 10:43:31 AM UTC
I notice that the old swivel has a grease fitting (zerk) that was likely never used. The new one also so perhaps you should suggest to the principal that he have it serviced once a year or so.
Friday, April 20, 2012 12:53:41 PM UTC
Wow! I had an insect on my eye while riding a bicycle when I was a kid and I never forgot the delightful experience.

Who told that developers have no practical life importance? Thanks to your software investigation skills you solved this "hardware" one.

Wish the kid get healthy soon and provide you other sort of new problems, the good ones at least like the bees story, etc...
Rogerio Prudente
Friday, April 20, 2012 12:58:46 PM UTC
Eyes are not anything to mess with. Good on you for taking care of it right away.
Friday, April 20, 2012 2:03:51 PM UTC
Oh, geezz.. can you put at least some opacity on that image and format it as being too explicit? See http://microformats.org/wiki/xrate
Friday, April 20, 2012 2:07:50 PM UTC
Great Sleuthing!
Friday, April 20, 2012 3:44:10 PM UTC
I feel for your kids. Had the same thing happen to me when I was remodeling my kitchen and cutting some old galvanized pipe out with a sawzall. A flake of metal got in my eye, rusted overnight, and I had to meet the eye-dremel. Not fun, and even worse when it's your little ones.

Great detective work!
Friday, April 20, 2012 3:56:05 PM UTC
Good to read that your son's eyesight will not be affected. Being a dad of a six-year old daughter who is playing with such playground stuff daily it gave me goosebumps. Hug you son and tell him that he's a lucky guy - both for getting metal in his eyes twice without long-term consequences as well for having really great parents! Excellent piece of hardware debugging.
Friday, April 20, 2012 3:56:41 PM UTC
Wow! Thanks for sharing. Glad everything worked out.
Friday, April 20, 2012 5:03:21 PM UTC
Great read! I have two girls and while they've had some "incidents" little boys tend to work hardest at self-destruction. Good news though, I hear it ends in their mid-30s.
Adam Ulvi
Friday, April 20, 2012 6:49:48 PM UTC
Ambigupus Stack trace parsed successfully----Root Error detected----Real World location:The playground swing.---- @Compiler version: ∞ Codename:Scott Hanselman
Friday, April 20, 2012 7:25:43 PM UTC
Hanseleminutes CSI
Friday, April 20, 2012 8:09:45 PM UTC
I guess the maintence guy doesn't grease those hangers, if ever.
Friday, April 20, 2012 8:26:33 PM UTC
When my daughter was almost 4, she accidentally got a popsicle stick stuck into her eye socket, perhaps 1" into it. I had just enough composure not to pull it out myself, but while I was "encouraging" (heh) my wife to call 911, my daughter pulled it out.

Ambulance, trip to the ER, pediatric opthamologist, etc. By the time the opthamologist got there, the eye was swelled up as if there were a golf ball underneath her eye lid. He had to use special retractors to separate her eye lids and look into the eye, *twice* (once for the eye drops to dilate, the second to look in). My wife, a nurse, and I had to hold her still for this. We were all a wreck.

No lasting damage, barely visible scars. She's a beautiful 20 year old today.

In our case, the root cause was jumping off the back of a coach with a popsicle stick in her hand while her brothers had string tied all around the floor.
Donnie Hale
Saturday, April 21, 2012 1:02:44 AM UTC
+1 for the comment about effing magnets.
Burton
Saturday, April 21, 2012 1:42:38 AM UTC
Awesome post!
Saturday, April 21, 2012 6:32:46 PM UTC
Did any other kids who played on that playground swing get metal in their eyes?
Saturday, April 21, 2012 6:57:12 PM UTC
This was of particular interest to me, a physician/programmer that's removed many a foreign body. Interesting too that Sir Arthur Conan Doyle was an Ophthalmologist.
Monday, April 23, 2012 10:31:07 AM UTC
I've done the trip to the hospital for this exact thing. Twice in one month. I was grinding though, but I wore eye protection, which made it even more frustrating.
Monday, April 23, 2012 12:09:26 PM UTC
I had the exact same thing in my eye, it felt like a stuck eye lash but when I still had the problem three days later I was concerned so went to my local optometrist.

She managed to remove the piece of metal using anesthetic eye drops and a swab. My eye was sore for a few days but she told me that if I had left it in there for a few more days I would have needed surgery to remove it.

If I get any problems in my eyes again, I'm going straight to ER. :-)



Mark Robinson
Monday, April 23, 2012 1:18:27 PM UTC
I’ve had a piece of metal in my left eye that had rusted. I noticed it one night when I rubbed the unaffected eye and noticed that anything that was illuminated had a halo around it. The eye doctor said the metal was hot enough when it hit the cornea that it embedded into it. The halo was from the rust. Something to numb the eye a few tools and some wash later and all was good. I had absolutely no discomfort at any time, just the halo. I’m glad you found the culprit.

Phil
Tuesday, April 24, 2012 12:44:20 AM UTC
Wow kudos to you for figuring that out.

Did anyone else's eyes water the entire time reading this? Brrrr!! Eye stuff freaks me out!
Tuesday, April 24, 2012 2:32:34 AM UTC
Amazing - great find - as a father of a few young ins I sympathize with trying to get them calm, etc... Especially in doctor offices - your son is brave :)

Glad you found the cause for your son and others that play there!
Friday, April 27, 2012 4:11:03 AM UTC
Wow, that's scary and weird. Also quite the detective story. You get the "Nancy Drew Award" for parenting.

Glad everything worked out.
Monday, April 30, 2012 5:33:13 PM UTC
Another reason why I read this blog. .NET, check. C#, check. Child-safety, check. Scott, my wife is a pediatrician and I'm forwarding this to her.
Tuesday, May 01, 2012 11:47:28 AM UTC
One of the most excruciating experiences in life is to have to take your kid to a doctor because they're in some sort of pain. I'm glad thing are alright now. :)
José Gómez
Monday, October 01, 2012 8:58:08 AM UTC
Hi Scott,

Apparently they are reading your blog at the one of the biggest danish newspapers.
, as they now report that swings are causing children eye damage.

Thanks for a great blog and the heads up regarding metal swings or should I say heads down.
Simon
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Disclaimer: The opinions expressed herein are my own personal opinions and do not represent my employer's view in any way.