2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part II: Periocular Soft Tissues
Chapter 11: Reconstructive Eyelid Surgery
Burns of the eyelid are rare and are generally seen in patients who have sustained significant burns over large areas of the body. Often, these patients are semiconscious or heavily sedated and require ocular surface protection to prevent corneal exposure, ulceration, and infection (Fig 11-6). Lubricating antibiotic ointments, moisture chambers, and frequent evaluation of both the globes and the eyelids are part of the early treatment of these patients. Once cicatricial changes begin in the eyelids, relentless and rapid deterioration of the patient’s ocular status often ensues secondary to cicatricial ectropion and eyelid retraction (Fig 11-7), lagophthalmos, and corneal exposure. If tarsorrhaphies are used, they should always be more extensive than seems to be immediately necessary. Unfortunately, with progression of the cicatricial traction, even the most aggressive eyelid adhesions may dehisce. In the past, skin grafting was usually delayed until the cicatricial changes stabilized, but the early use of full-thickness skin grafts, amniotic membrane, and various types of flaps can effectively reduce ocular morbidity in select patients. Cicatrization may also be reduced with the early use of ablative fractional laser and wound modulators (5-fluorouracil).
Figure 11-6 Facial burns with no corneal exposure.
(Courtesy of Cat N. Burkat, MD.)
Figure 11-7 Cicatricial right lower eyelid ectropion after extensive facial burns.
(Courtesy of Bobby S. Korn, MD, PhD.)
Lee BW, Levitt AE, Erickson BP, et al. Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil for the treatment of cicatricial ectropion and periocular scarring. Ophthalmic Plast Reconstr Surg. 2018;34(3):274–279.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.