S. J. Day1, A. Patel1, D. E. Bell1 1University Of Rochester,School Of Medicine And Dentistry,Rochester, NY, USA
Introduction: Facial burns with ocular involvement often lead to significant morbidity. This study aimed to identify risk factors for short- and long-term ophthalmic complications in facial burn patients. Upon validation, these risk factors could distinguish patients who require ophthalmologic evaluation and prompt intervention.
Methods: Retrospective case review was conducted of facial burn patients presenting to an American Burn Association-verified regional burn center from June 2007 to May 2016. Demographic, injury-related, and hospitalization-related variables were assessed for correlation with short- and long-term ophthalmic complications. Short-term complications included visual loss on presentation, lagophthalmos, ectropion, chemosis, ocular hypertension, chalasis, conjunctival necrosis, and orbital or periorbital infection. Long-term complications included lagophthalmos, cicatricial ectropion, exposure keratopathy, scleritis, and corneal stem cell deficiency.
Results: From June 2007 to May 2016, 1126 facial burn patients presented to a regional burn center’s inpatient and outpatient settings. One hundred thirty-seven (12.2%) had associated periorbital and orbital injuries. Of the ocular burns, 66.4% were male and 75.9% were Caucasian. Average total body surface area (TBSA) burned was 9.72% (range, 0.02 – 75.13%), and average facial surface area burned was 1.64% (range, 0.02 – 6.65%). One hundred and twenty patients (87.6%) received an ophthalmologic consult. Sixty patients (43.8%) developed short-term ophthalmic complications, with the most common being chemosis (n = 36, 26.3%). Eight patients (5.8%) developed long-term complications, with the most common being lagophthalmos (n = 4, 2.9%). Two flash burn patients (1.5%) developed cicatricial ectropion and underwent full-thickness skin grafts to the eyelids. One scald burn caused a localized corneal stem cell deficiency, which led to chronic keratitis requiring long-term steroid treatment.
Statistically significant risk factors (p < 0.05) for both short- and long-term ophthalmic complications included inhalation injury, higher percentage of body with 3rd degree burns, and presence of corneal injury.
Presence of short-term complications was significantly associated (p < 0.05) with advanced age, higher TBSA burns, and higher percentage of body with 2nd degree burns. Significant associations (p < 0.05) with the development of long-term complications included active smoker status, 3rd degree eyelid burns, periorbital edema, need for intubation, longer duration of mechanical ventilation, visual loss on presentation, chemosis, lagophthalmos, ectropion, bloodstream infection, and longer length of hospitalization.
Conclusion: Providers should obtain early ophthalmologic evaluation for facial burn patients who present with advanced age, active smoking status, inhalation injury, 2nd and 3rd degree burns, or need for intubation.