Ophthalmologic sequelae of thermal burns over ten years at the Alfred Hospital

Purpose: To study the ocular outcomes of facial bums over a 10-year period at the Alfred Hospital; in particular, to investigate the impact of 3 variables (grading of bum, use of prophylactic ocular surface lubrication, and timing of ophthalmologic referral) on the requirements for eyelid surgery. Methods: A retrospective review of patients admitted to the Alfred Hospital (from October 1990 to October 2000) after thermal burns with facial, eyelid, and ocular involvement. Results: Sixty-six patients were identified with facial bums involving the lids or eyes, having been admitted over a 10-year period. Of these 66, 7 died of complications of the bums and 12 required eye or eyelid surgery. Of those patients treated with prophylactic ocular surface lubrication, the rate of ocular surgery was 18.4% as opposed to 30% when no prophylaxis was used. The higher the percentage of total bum, the later the referral was made. Of those with severe eyelid bums, 100% had eyelid surgery and 50% of moderate bums had eyelid surgery. Sixty percent of moderate eyelid bums that required surgery did not receive prophylaxis. Thirty-four of 66 patients had acute corneal involvement, but only 3 eyes of 118 had long-term corneal morbidity. Conclusions: The requirement for eyelid surgery was closely related to the severity of the eyelid bum. The presence of an acute corneal bum with epithelial loss was not a poor prognosticator. The use of prophylactic ocular surface lubrication may provide early corneal protection, thereby minimizing ulceration in patients who may otherwise have required surgery, especially in those with mild to moderate exposure. Prompt ophthalmologic examination and the early use of prophylactic ocular surface lubrication for the cornea are associated with less need for eyelid surgery in patients with moderate eyelid burns.