Ocular injuries associated with facial burns

Dr Henry Shepherd1, Dr Andrew Turner1, Dr Aruna Wijewardana1, Dr John Vandervord1, Dr Jeon Cha1

1Royal North Shore Hospital

Patients who sustain facial burns are at risk of ocular injury. Facial burns may directly injure the globe or may cause indirect damage through ocular exposure. Indirect exposure may result from a blunted Bell’s and blink response secondary to sedation, or from eyelid retraction. The aim of this study was to analyse the incidence, mechanism and sequelae of ocular injuries amongst patients who were managed for facial burns at Royal North Shore Hospital between January 2013 and January 2017. 279 patients sustained facial burns during this period and 28% (79/279) were referred to ophthalmology to exclude ocular injury. Mechanisms included flame (65/79), chemical (10/79), steam (2/79) and electrical flash (2/79) burns. Of those, 29% (23/79) sustained an immediate globe injury. Seventy percent of chemical burns resulted in an immediate globe injury compared with 22% of flame and 100% of steam burns. Twenty percent (16/79) of referred patients sustained eyelid burns and 25% (4/16) of these required skin grafting. Thirty one percent (5/16) of patients with eyelid burns sustained immediate ocular injuries, 60% (3/5) of which were caused by chemicals and 40% (2/5) by flames.  The resultant sequelae from these ocular injuries included one patient who had persistent discomfort and mild visual impairment and another had unilateral subepithelial scarring with minimal symptoms. The remaining patients had no long-term sequelae. Clinicians carry a high index of suspicion for ocular injuries as a result of facial burns. Despite this, very few facial burns result in ocular injuries with significant ongoing morbidity.

Henry is an Unaccredited Burns and Plastics Registrar at Royal North Shore Hospital in Sydney.

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