Risk Factors for Ocular Burn Injuries Requiring Surgery

Abstract

The surgical management of severe ocular burns is challenging and often associated with variable long-term outcome. The aims of this study were to analyze the clinical course of these injuries and determine the factors associated with the need for surgery. A retrospective medical records review was conducted for patients admitted to the Victorian Adult Burns Services, with ocular burns, from January 2000 to January 2010. One hundred and twenty-nine patients were admitted with ocular burns, of which 17 (13.2%) required surgery. The most common indication for surgery was ectropion (n = 9) and the most frequent procedure was full-thickness skin grafts to the eyelids (n = 10). Almost all patients managed surgically developed late ocular complications, the most frequent being visual loss and recurrent ectropion (n = 7 each). Patients undergoing surgery had a longer length of hospital stay (median [interquartile range] 40 [12-90] vs 12 [4-29.5] days; P = .004) and larger TBSA burned (median [interquartile range] 20 [10-60] vs 8 [4-20]; P = .011). Factors associated with the need for surgery included flame burns, periorbital edema, visual loss on presentation, increasing severity of eyelid and facial burns, severe corneal injury, as well as lagophthalmos, ectropion, and microbial keratitis (P < .05). Although only a minority required surgery, these patients often require multiple procedures and develop long-term ocular morbidity.

Acute surgical vs non-surgical management for ocular and peri-ocular burns: a systematic review and meta-analysis

“…Following title/abstract review, 7924 articles were excluded and 534 articles were eligible for full-text review. Following full-text review, 8 articles were eligible and included in the systematic review (Table 1) [2, 15–21]. All 8 articles were eligible for final data extraction and meta-analysis (Fig.…”

“…These 272 surgical cases were compared to 535 non-surgical cases. The most reported anatomical structure was the eye (7/8 studies) [2, 16–21], surgical intervention was AMT (5/8 studies) [16, 17, 19–21], outcome was visual acuity on initial evaluation and at follow-up (5/8 studies) [16–20], and complication was corneal vascularization at follow-up (6/8 studies) [16–21]. The eyebrow was reported in 0/8 studies.…”

“…The eyebrow was reported in 0/8 studies. There were three RCTs [16, 19, 21], one prospective cohort [17], and four retrospective cohort studies [2, 15, 18, 20], published in English. Five studies were performed in India [16, 18–21], one in Spain [17], one in Australia [2], and one in the USA [15].…”

“…Burn injury to ocular structures requires patient transfer to specialized burn centers, where early evaluation by an oculoplastic surgeon may prevent long-term morbidity [1]. The majority of ocular burns do not require surgical interventions, and rates of long-term morbidity have been reported as low as 4.5% with medical management alone [2–4]. Prior associated risk factors identified for surgical interventions after ocular burns have been deep eyelid burns, flame burns, increasing severity of corneal injuries, periorbital edema, visual loss on presentation, and keratitis [2].…”

Periorbital lesions in severely burned patients

“…In an Australian study reported by Cabalag et al, from a total of 3340 burns admissions, around 35% suffered facial burns with 12% involving the orbital/ periorbital region [ 11 ]. In another study on a large number of patients (4758 patients: 2346 adults and 2412 children) from United Kingdom, 18% of the burns involved the face and 2% were periorbital burns requiring surgical treatment [ 4 ].…”