Multidisciplinary Treatment to Restore Vision in Ocular Burns

Abstract

<jats:title>Abstract</jats:title> <jats:p>Periorbital burns generate contraction and distortion of periorbital soft tissue, causing eyelid malfunction, further contributing to loss of vision from corneal scarring or perforation. We present our multidisciplinary algorithm to restore vision in patients with burn-related bilateral corneal blindness with light perception. Chart review was performed for four consecutive burn patients requiring periocular reconstruction and keratoprosthesis. Initial treatment included globe coverage with eyelid releases and grafts. Strategy of corneal replacement was determined by eyelid position and function and sufficiency of tear production. All patients were corneal blind with light perception only and cicatricial ectropion. The eye with better visual prognosis was reconstructed. Eyelid reconstruction procedures consisted of lid releases with full-thickness skin graft (FTSG) or split-thickness skin graft (STSG). Two patients regained adequate lid function and underwent standard keratoprosthesis placement. Two underwent mucous membrane grafts followed by keratoprosthesis. All patients experienced improved postoperative vision in their reconstructed eye. Corneal injury due to periocular burns can lead to blindness. Early involvement of ophthalmology, protective measures, and early ectropion release are critical. For severe burns, a multidisciplinary approach, where adequate globe protection is followed by keratoprosthesis placement, can effectively restore vision in patients with burn-related corneal blindness.</jats:p>

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

“…The goals of eyelid reconstruction include restoring eyelid structures and functions, achieving a cosmetically acceptable appearance with minimal surgical morbidity, and, more importantly, maintaining ocular surface homeostasis to prevent visual impairment [ 3 , 4 ]. To achieve these goals, the reconstructive strategy should be well planned based on reconstructive ladder principles and defect characteristics.…”

Management of facial burns: an update

“…During burn injury to the face, the eyes themselves are protected by the blink reflex and by the Bell's reflex if the eyelids close incompletely, making burns to these structures less frequent, protecting the globes. When but when burns to these areas do occur, they can lead to significant complications with the eyelids, even with intact and visual globes, such as ectropion, entropion, lagophthalmos and cicatrical scarring due to contraction and distortion of the periorbital soft tissue which can be severe, and extremely challenging to correct [32][33][34]. Early tarsorrhapy has been found of value in full thickness facial burns in the peri-ocular areas and, recently, temporary lateral eyelid tarsorrhaphy with Froststyle suspensory stitching, but in a more lateral location, has been described by Lymperopoulos et al [35], as helpful to mitigate contracting forces during healing of burns to the lower eyelid and cheek while not completely obscuring vision.…”

Scleral Contact Lens to Preserve a Corneal Graft in Chronic Lagophthalmos

“… 4 Injury to the globe, eyelids, orbit, and ocular adnexa predispose these patients to eyelid deformities, conjunctival scarring, and corneal disease, leading to visual impairment and blindness. 5 , 6 , 7 …”