Eyelid Burns Research Articles

Design and Validation of a Preclinical Model for Oral Commissure and Lower Eyelid Thermal Injury

IntroductionOral commissure stenosis and lower eyelid ectropion from burns are functionally impairing and challenging to treat. Evaluation of various treatment modalities is limited by a lack of preclinical models. Described is a method for inducing controlled, titratable oral commissure and lower eyelid burns in swine for future treatment research. MethodsBurn wounds 3cm in diameter were applied to the lower eyelid and oral commissure of seven anesthetized Yorkshire swine for 10, 15, 20, or 30seconds at 100°C with a custom designed thermocouple-controlled burn device and observed for 3, 30, or 90 days. Tissue underwent laser speckle imaging (LSI) to assess vascular perfusion and histologic analysis after harvest. Statistical comparisons were calculated using Wilcoxon rank-sum tests. ResultsSubdermal extension was noted in oral commissure and lower eyelid burns with contact time of 20seconds or greater. Wound area progressively contracted from post-operative day (POD) 0 to 90 in both sites, but was not statistically significant based on contact time or burn site (p>0.20). Burns of 20-30seconds demonstrated increased neutrophil influx for oral commissure injuries (p<0.01) and leukocyte and macrophage influx for lower eyelid injuries (p=0.02). Degree of vascular congestion increased with 20-30second burns in both the oral commissure (p=0.015) and lower eyelid (p=0.04). Normalized LSI readings showed increased speckle size in both oral commissure (4.0-fold increase, p<0.01) and lower eyelid (3.2-fold increase, p<0.01) burns on POD 90 compared to pre-injury. No change in oral or ocular function was noted in any of the groups (p = 0.96). ConclusionOral commissure and lower eyelid burns create scars which may be modified by burn duration. This model may evaluate a therapeutic’s ability to limit functional impairment from burns.

FP7.20 - Peri-orbital burns: A 5-Year Review of the Epidemiological Characteristics and Outcomes at a Regional Burns Centre in the UK 2019 – 2023

Abstract Background Burn injuries are a major cause of global morbidity. Despite being infrequent, peri-orbital and ocular burns can have significant implications on a patient’s vision and overall quality of life. In Northern Ireland, the current epidemiological landscape of peri-orbital burns is not clear. This study aimed at assessing the incidence of peri-orbital and ocular burns and the management outcomes of patients admitted at the regional burns unit in Northern Ireland 2019-2023. Methods Patients admitted to the regional burns unit in Northern Ireland between January 2019 and September 2023 with periorbital burns were identified from the burns unit electronic records, the burns unit database and hospital image database. Results Over 5 years, 100 patients with facial burns were treated, including 60 patients with eyelid burns. 71% were males and 29% were females with a mean age of 47 years. The mean burn size was 14% total body surface area. The burn depth varied; 55% superficial partial thickness, 22% mixed, 17% full thickness and 6% deep dermal. Majority of burns were flame burns 64%. In total, 7 patients sustained corneal burns, one patient responded to steroids, one underwent amniotic membrane grafting, one lost complete vision in both eyes, one had physical debridement and topical antimicrobials and three patients required periorbital reconstruction to maintain eye closure. Conclusion 60% of Facial burns were associated with eyelid burns, the majority of which were caused by flame burns and were managed conservatively with wound cleaning, physical debridement, and application of topical antimicrobials. Despite being rare, complete loss of vision was associated with mortality among our patients.

Fourteen-Year Experience in Burn Eyelid Reconstruction and Complications Recurrence: A Retrospective Cohort Study.

Loss of vision and other ocular defects are a concern with eyelid burn sequelae. This most commonly progresses from eyelid contracture to cicatricial ectropion and lagophthalmos. When left untreated, these may lead to exposure keratitis, ulceration, infection, perforation, and loss of vision. In the case of full-thickness eyelid burns, release and grafting are required. However, there is a paucity of studies on outcomes in eyelid burn surgery treatment, despite concern for permanent ocular damage or loss of vision. The aim of the study is to describe the complication rates in burn eyelid reconstruction at a single center for 14 years. A retrospective cohort study was performed of all patients who had sustained eyelid burns and required reconstruction between April 2009 and February 2023. Medical records were obtained from patients' charts. Collected data include demographics, medical history, type of injury, indication for surgery, procedure performed, and complications. A total of 14 patients and 25 eyelids underwent eyelid reconstruction of the 901 total patients with burn-related injuries requiring plastic surgery reconstruction. These patients underwent 54 eyelid surgeries with a mean follow-up time of 13.1 ± 17.1 months. Patients were 71% men and 29% women, with a mean age of 45.1 ± 15.6 years. In 53.7% (n = 29) of the cases, the simultaneous reconstruction of both the upper and lower eyelids was necessary. The reconstruction of the upper and lower eyelid alone represented a smaller percentage (25.9% and 20.4%, respectively). On average, the patients received 3.9 ± 3.5 eyelid surgeries. The overall complication rate was 53.7% (n = 29). The most common complication was ectropion (42.6%, n = 23). Other complications included eye injury (25.9%, n = 14), lagophthalmos (24.1%, n = 13), local infection (7.4%, n = 4), and graft loss (5.6%, n = 3). Periorbital burns represent a major challenge that may require complex surgical intervention. Full-thickness skin graft remains the standard of care for patients with eyelid burns. However, there is a high incidence of ectropion that may require reoperation. Further studies examining the conditions of successful eyelid burn procedures may provide guidance on when patients may benefit from eyelid reconstruction during their burn treatment.

The Effect of Aloe Vera Topical Gel Extraction on Tgf-Β1 Expression in Thermal Burn Eyelid Grade II Rats Model

Grade II eyelid burns are burns that reach the epidermis and part of the dermis of the palpebrae and can have impaired wound healing. TGF β1 has the broadest spectrum of action, affecting all cell types involved in all stages of wound healing. TGF β1 increases rapidly after injury and reaches peak levels three days after injury, which coincides with the peak of the inflammatory phase of wound healing. Decreased expression of TGF β1 is associated with impaired wound healing. Aloe Vera has long been known in Indonesia as a healing plant. Aloe Vera extract contains a variety of bioactive compounds that play a role in stimulating wound healing. The administration of Aloe Vera extract on thermal burns aims to reduce inflammation, increase collagen content, and increase the rate of re-epithelization. The administration of Aloe Vera gel extract allows faster healing of thermal burns and rebuilds the vascularity of the wound tissue. Objective of this study is to determine the difference between the expression of Transforming Growth Factor Beta 1 (TGF β1) in a rat model of thermal burn injury grade II of the eyelids treated with topical Aloe Vera gel extract with the concentrations of 20%, 40%, Balanced Salt Sodium (BSS) and a control group that was not given burn intervention. An experimental study with the post-test-only approach with a control group design. 24 Rats have induced grade II eyelid thermal burns, divided into four groups: Normal (without treatment), negative control (BSS), given Aloe vera 20%, 40%. Then TGF β1expression was quantified using the Image J application. The Topical application of Aloe vera gel can increase the expression of TGF along with the increase in dose. The highest rise in TGF expression was found in the group with 40% Aloe vera gel, followed by 20% Aloe vera gel compared to the negative control (BSS Balanced Salt Solution). Aloe Vera can increase TGF expression in a rat model of grade II palpebral burn injury and is dose-dependent.

Orbital Compartment Syndrome in Severe Burns: Predictive Factors, Timing, and Complications of Intervention.

Severe burn patients require high-volume fluid resuscitation, which increases risk for orbital compartment syndrome (OCS). We aimed to understand surgeons' practice patterns and to examine risk factors for OCS, timing of lateral canthotomy and cantholysis (LCC), and complications of intervention. A survey of American Society of Ophthalmic Plastic and Reconstructive Surgery and North American Society of Academic Orbital Surgeons' practice patterns in burn patients was undertaken. In addition, a retrospective analysis was conducted of 107 patients with burns greater than 20% total body surface area at 1 institution from January 1, 2009, to June 1, 2018. Patients with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, frostbite, or no ophthalmologic consultation were excluded. Risk factors for OCS, timing of LCC, and complications of the intervention were examined. In the survey, 37 of 54 respondents had treated burn patients, of which 29 followed no protocol. Threshold intraocular pressure for intervention varied widely, and nearly all reported having seen complications from LCC in burn patients. For the retrospective analysis, 107 patients met criteria, of which 22 (20.6%) required LCC. Renal failure, inhalation injury, eyelid burns, higher total body surface area, elevated lactate, increased number of escharotomies, and greater total fluid required were significantly associated with the clinical decision that the patient was at risk for OCS requiring LCC. Fluid resuscitation in excess of the Ivy Index (250 ml/kg) increased odds of LCC 8.6 times. Average time of LCC was 15.8 hours after burn. LCC patients experienced higher rates of complications including eyelid retraction, exposure keratopathy, and corneal ulceration. Severe burn patients should be monitored closely by an ophthalmologist during the first 48 hours for signs of OCS. Further studies should aim to recommend protocols guiding evaluation and intervention.

550 Considerations for Ophthalmologic Evaluation to Reduce Ocular Morbidity in Facial Burn Patients

IntroductionAdvances in burn management have led to significant improvement in survival rates, even in patients with high total body surface area (TBSA) affected. Ocular morbidity in facial burn patients remains high, partially attributable to the life-threatening nature of these injuries. Previous studies have shown that early ophthalmologic intervention leads to better outcomes, however, specific risk factors for short and longer term ophthalmologic outcomes have not been elucidated. This study aimed to identify risk factors for short- and long-term ophthalmologic complications in facial burn patients to prioritize patients that require urgent ophthalmologic evaluation.MethodsRetrospective review of facial burn patients presenting to an American Burn Association-verified regional burn center between June 2007 and May 2016 was conducted. Demographics, presentation, time to ophthalmologic consultation, and short- and long-term complications were recorded. Odds ratio and multivariate analyses were performed to assess for significant risk factors.ResultsA total of 1,126 facial burn patients were identified, of which 135 (12%) involved periorbital and orbital injury. Average TBSA burned was 9.68%, with an average facial surface area burned of 1.56%. The most common ocular injury was eyelid burn (65.9%). Ophthalmology was consulted for 118 (87.4%) patients. Short-term ophthalmologic complications were noted in 58 (43%) patients, most commonly chemosis (n = 34, 25.2%). Long-term complications were rare, occurring in only 7 (5.2%) patients.Odds ratio analysis revealed that inhalation injury significantly increased the likelihood of both short- and long-term complications (OR 3.16 and OR 9.81, respectively). Active smoking increased the likelihood of long-term complications (OR 14.76). Ophthalmologic intervention, including need for consult, and use of lubricant, antibiotics, or steroids were each associated with increased risk of short-term complications.On multivariate analysis, those with long-term complications tended to be older (p = 0.045). Those with corneal injury generally had worse outcomes, with higher likelihood of short- and long-term complications (p < 0.001, p = 0.057, respectively).Blindness did not occur in any patient, and no long-term complications occurred in those who did not receive ophthalmologic consult. Neither TBSA nor facial SA burned was associated with the development of short- or long-term complications.ConclusionsProviders should obtain early ophthalmologic evaluation and frequent follow-up exams for facial burn patients presenting with advanced age, active smoking status, corneal injury, or inhalation injury to reduce development of long-term complications.

Treatment of upper eyelid third-degree burns by dispersed implantation of very small autologous columnar skin grafts: A pilot study of a new method

ObjectiveThis retrospective study compared the effectiveness of dispersed implantation of very small autologous columnar skin (SCS) grafts and full-thickness skin grafts (FTSGs) for treating upper eyelid third-degree burns. MethodsFourteen patients and 26 eyes with granulation tissue formed by third-degree upper eyelid burns were enrolled in the study from August 2017 to June 2020. The experimental group of 6 patients with 11 eyes was treated with SCS grafts. The control group of 8 patients with 15 eyes was treated with FTSGs. The survival rate of the grafts, healing time, SCS diameter, upper eyelid movement distance (ULMD), visual analogue scale (VAS) score for patient satisfaction, and Vancouver Scar Scale (VSS) score were evaluated. ResultsThe difference in the survival rate between the two groups was not statistically significant (P = 0.06). The ULMD and VAS scores in the experimental group were higher than those in the control group (P < 0.05). The healing time was longer in the experimental group than in the control group (P < 0.05). The VSS scores of the donor site and the skin grafting site in the experimental group were lower than those in the control group (P < 0.05). ConclusionUnlike classical skin grafts, SCS implantation surgery can restore the appearance of the upper eyelid, and there is no obvious scar at the donor site. This can be a viable alternative to traditional FTSGs with potential benefits

Characteristics of eye injuries in urgently hospitalized adults in the Perm region

A retrospective analysis of 136 medical histories of patients with eye injuries who applied to the city and regional centers of emergency ophthalmological care and were hospitalized in two specialized ophthalmological departments during one calendar year was carried out. 89% of patients were men, 11% were women; 20% contacted hospitals in winter, 21% – in spring, 30% – in summer and 29% – in autumn. Out of 139 injured eyes, 50% were wounded, 40% were contused, 10% had burns. In cases of eye injuries, 7 (10%) were injuries of the appendages of the eye, 57 (81%) were penetrating injuries, 66% were corneal injuries, 25% – scleral injuries, 9% – corneal-scleral injuries, all of which were severe; 3% – non-penetrating injuries of the cornea, 6% – penetrating injuries of the orbit. Among 56 contused eyes, appendages of the eye were damaged in 4 (7%) eyes, all of them were of 2nd degree of severity. Eyeball damage was diagnosed in 35 (63%) eyes: 17 were of 2nd degree of severity, 15 – of 3rd degree of severity, 3 – of 4th degree of severity. Multisystem injuries of the eyeball and appendages of the eye were diagnosed in 17 (30%) eyes. Corneal, conjunctival and eyelid burns of the 2nd degree were diagnosed in 9 eyes, while burns of the 3rd degree were diagnosed in 4 eyes. All cases were chemical burns. 87% cases were civilian injuries, 11.5% were work injuries, while 1.5% were caused by criminal actions. In 2 eyes with non-penetrating corneal injuries, the visual acuity increased after discharge from hospital. Out of 57 eyes with penetrating injuries, the visual acuity increased in 34 eyes and decreased in 8 eyes; in 3 cases of visual acuity decrease, an ophthalmectomy was performed; in 15 eyes the visual acuity remained unchanged. In cases of contusion of the eyeball, out of 52 eyes the visual acuity increased in 39, decreased in 1 eye and remained unchanged in 12 eyes. In cases of burns, out of 13 eyes the visual acuity increased in 10 eyes and remained unchanged in 2 eyes. One patient underwent a blepharorrhaphy.Conflict of interest: Gavrilova T.V. is the member of the editorial board of the journal and has been recused from review process and from making decision regarding acceptance of this article.

A New Way of Managing Canalicular Injury Associated With Late Eyelid Burns.

This study aimed to introduce a new way to rebuild the canalicular system of patients with occluded punctums after long-time burns. Cases with eyelid burns associated canalicular injury presented at Eye Hospital of Wenzhou Medical University from June 1st, 2015 to September 30th 2017 were referred to department of Orbital & Oculoplastic Surgery. Cases with occluded both superior and inferior punctuns were recommended to surgery. Twenty-seven cases were enrolled in our study. Patients were followed up at 1, 2, and 4 weeks and 3, 4, 6, and 12 months postoperatively. Success of the surgery was defined as being free of epiphora and purulence postoperatively, a normal functional endoscopic dye test, free-flowing irrigation through the lacrimal system, and the presence of upper and lower punctum ostium. With a follow-up of 12 months postoperative, there were 22 cases that showed surgical success outcome according to the set criteria. The success rate of our surgery is 81.48%. The surgical procedure used in our study is an effective and easy way to treat patiens with occluded punctum after long-time burns. The utility of silicone intubation is necessary and delayed tubing removal maybe meaningful in these kinds of patients.

Risk Factors for Ocular Burn Injuries Requiring Surgery

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.

A lateral tarsorrhaphy with forehead hitch to pre-empt and treat burns ectropion with a contextual review of burns ectropion management.

Introduction:Facial burns around the eyes and eyelid ectropion can lead to corneal exposure, irritation, dryness, epiphora, infection or visual loss. We undertook a review of the published articles describing management of eyelid burns as well as methods to treat or prevent ectropion. We describe early experience of a surgical technique that we have found to mitigate ectropion in facial burns with peri-ocular involvement.Materials and methods:Two illustrative cases with our surgical technique is described from our experience of three cases. We reviewed the literature using the PubMed and EMBASE databases using the search terms ‘burn’ and ‘ectropion’.Results:The literature review produced a total of 17 relevant papers. Treatment options for eyelid burns were varied and were invariably level 4 or 5 evidence. Various techniques were used to treat eyelid burns including the use of a full thickness skin graft with or without concurrent scar contracture release but also use of a local flap reconstruction with or without a tissue expander or release of the underlying muscle. Other techniques included canthoplasty, Z-plasty, forehead flaps, fat transfer, and tarsorrhaphy with full thickness skin grafting. In general, the focus of articles was therapeutic and reconstructive rather than pre-emptive/preventative management.Procedure:We describe our early experience of a novel technique for temporary lateral tarsorrhaphy with forehead hitch which protexts the globe and counters the scar- and gravity-related ectropic effects on the lower eyelids.Discussion:Facial burns pose a difficult problem to the burn surgeon, especially when the eyelids are affected, both directly or indirectly. The optimal surgical management of eyelid burns remains unclear and the literature base lies mainly in the domain of case series. We review the literature on this subject and tabulate our findings and also describe our contribution to this area with a method of lateral and lower lid elevator that we have found valuable.

Early and late complications of ocular burn injuries

Ocular involvement in facial burns may lead to significant long-term morbidity. The aims of this study were to analyse the epidemiology, management and outcomes of ocular burn injuries, as well as to identify risk factors for developing early and late ocular complications. A retrospective medical chart review was conducted for 125 patients with ocular burns who were admitted to the Victorian Adult Burns Service (VABS), from November 2000 to January 2010. Univariate analyses was utilised to identify demographic and injury related variables associated with early and late complications. The majority of patients were male (n=101, 80.8%), and the mean (range) age was 40.7 (15-86) years. The most common mechanism was flame burns (n=77, 61.6%), and most were accidental (n=114, 91.2%). Early ocular complications occurred in 50 (40.0% [95% CI: 31.3%-49.1%]) patients, with the commonest being visual loss (n=39, 31.2%). Chemical burns, ocular discomfort, peri-orbital oedema, corneal injury, as well as eyelid and facial burns of increasing severity were associated with developing an early complication. Late ocular complications occurred in 19 (15.2% [95% CI: 9.4%-22.7%]) patients, with visual loss being the most frequent (n=13, 10.4%). Chemical burns, ocular discomfort, corneal injury of increasing severity, visual loss on presentation, ectropion, as well as eyelid burns of increasing depth were associated with late morbidity. Chemical burns, ocular discomfort, as well as corneal injury and eyelid burns of increasing severity were risk factors for both early and late ocular complications. III (retrospective comparative study).

Periorbital burns – A 6 year review of management and outcome

IntroductionPeriorbital burns are an infrequent but potentially devastating injury. This study aimed to elucidate the spectrum of such injuries presenting to a UK burns centre and the outcome achieved in the cases requiring periorbital reconstruction for the restoration of function and form. MethodsPatients admitted to a UK regional burns centre between January 2005 and January 2011 with periorbital burns were identified from the Patient Administration System (PAS), theatre logs and the International Burns Injury database (IBID). Multiple parameters were assessed using patient notes, ITU and hospital image databases. ResultsOver 6 years, 167 patients with facial burns requiring surgery were treated, including 103 patients with eyelid burns. The mean burn size was 33% total body surface area. The eyelid burn depth varied; 67% superficial partial thickness, 17% deep dermal and 16% full thickness. Two patients lost complete vision in one eye, one patient underwent amniotic membrane grafting. In total 16 patients required periorbital reconstruction to maintain eye closure, with 1.8 operations on average per patient. Acute surgery was required in 11 patients, whilst late intervention (>3 months) was needed in 5, 2 patients had both acute and delayed surgery. Of the 5 late intervention patients 4 were treated with full thickness skin grafts and 1 with a Z plasty. Average time for final reconstruction with delayed surgery was 4.5 months. ConclusionThe goal in management of periorbital burns is preservation of vision, prevention of future complications and restoration of an acceptable aesthetic outcome. Total visual loss is thankfully rare, but early ophthalmology intervention is vital given the evidence of corneal damage as a brief therapeutic window exists.

Management of ocular and periocular burns

Facial burns commonly involve the eyelids. The eyeball as such is usually protected due to the blink reflex, bell's phenomenon, and protective movements of arms and head. Ocular sequelae are seen secondarily due to retraction of the burned eyelids which leads to drying of cornea and its subsequent ulceration and perforation. Permanent visual impairment is rare if prompt management is done. Superficial lid burns usually heal spontaneously and can be managed conservatively with ophthalmic antibiotic ointments, artificial tears. However, in deeper burns, early surgical intervention in the form of eschar debridement or release of contracted lids and resurfacing defects with split skin grafts can prevent secondary corneal damage. This review article elaborates the principles of management of acute ocular and periocular burns as well as the long-term management of eyelid burns.

Electrical Injuries in Urban Children in New Delhi

The objective of this study was to analyze the epidemiology, presentation, management, and complications of electrical burn injuries in urban children. Data from records and clinical data were collected retrospectively and prospectively during 2008 to 2010. Of 41 children enrolled, the mean age of children enrolled was 8.1 ± 4.5 years. Low-voltage injury was seen in 28 (68.2%), and 13 (31.8%) had high-voltage injuries. Low-voltage injuries were most commonly (52.45%) secondary to direct contact with live wire, whereas high-voltage injuries in 70% were due to direct contact with broken wires lying in fields/rooftops. Fourteen children of the 41 enrolled had associated injuries. Low-voltage injuries were associated with minor burns, seizures, tibial fracture, eyelid burn, scalp hematoma, and speech and visual impairment, whereas high-voltage injuries were associated with cardiac arrest, extradural hematoma, visceral burns, pulmonary hemorrhage and hypoxic encephalopathy, and postelectrocution acute respiratory distress syndrome. Surgical interventions done included split-thickness skin grafting, fasciotomy, and amputation procedures. The mean duration of hospital stay of all the children enrolled was 9.02 days with 35 children discharged, 71.4% of them having low-voltage injuries. Four children died, 75% of them having high-voltage injury, whereas 2 children left without medical advice, both having low-voltage injuries. Children are a major group susceptible to electrical injuries in our country. Most of the mechanisms leading to them are easily preventable, but occur because of lack or awareness among the children and their guardians. Burn prevention program should be implemented incorporating these epidemiological data.

A modified surgical technique in the management of eyelid burns: a case series

IntroductionContractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts.Case presentationWe present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up.ConclusionsThis new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid.

Burn during a Routine Pterygium Excision Operation

To report a patient who sustained a spark fire burn during a routine pterygium operation. A 40-year-old woman was referred for pterygium excision in her left eye. During the operation a low temperature cautery caused a spark fire that resulted in left eye corneal burn, upper and lower eyelid burns, and melting of eyelashes and eyebrows bilaterally. Topical antibiotics and vitamin C followed by topical corticosteroids were given. After 1 week the corneal epithelium healed but a paracentral corneal opacity developed. Two months later on last follow-up visit, a mild diffuse corneal opacity was still seen. The combination of three elements found in most routine (ophthalmologic) surgical fields-an enriched oxygen environment with the high temperature transmitted by the electrocautery in the vicinity of hair-might explain the event. Surgeons should try to separate these three elements or eliminate any of them, in order to minimize or prevent such events.

Ocular and Facial Injuries Associated With the Use of Immersion Heaters in an Inmate Population

To report ocular and facial injuries caused by the use of electric immersion heaters in an inmate population. Prospective observational case series. Data were recorded over a six-month period on age, gender, mechanism of injury, examination, and treatment of Dallas County inmates who experienced ophthalmic injuries from immersion heaters and were referred to a tertiary-care center. Eight male inmates were treated for thermal ocular injuries, which occurred within jail cells as a result of cooking explosions from electric immersion heaters, known by inmates as "stingers." All patients had thermal eyelid burns, either first- or second-degree facial burns, and corneal abrasions with corneal edema. Corneal metallic foreign bodies were removed in one patient, and three patients underwent debridement for corneal sloughing. Immersion heater-related accidents may cause thermal injuries within the inmate population. Physicians evaluating incarcerated patients with ocular trauma should be aware of immersion heaters as a common cause.

Treatment of bitumen burns: effective dissolution of hardened hydrocarbon residue on periorbital and eyelid burns using butter

Treatment of bitumen burns: effective dissolution of hardened hydrocarbon residue on periorbital and eyelid burns using butter

Ocular injury in children from exploding microwaved eggs

To report an ocular injury caused by exploding microwave-cooked eggs. Case reports. Two children exposed to exploding microwaved eggs were examined for facial burns and ocular trauma. One patient sustained mild corneal epithelial damage in both eyes and eyelid burn, which were treated conservatively. The other, injured in the same event, had symblepharon and moderate keratopathy requiring intensive lysis. Physicians should be alerted to the potential risk of vision-threatening ocular injury from exploding microwaved foods, and the public should be educated not to cook eggs in microwave ovens.