Eyelid Burn Reconstruction

Synopsis

The sequelae of facial burn injury can be devastating. Involvement of the eyelid area is of particular importance, both functionally and esthetically. It is essential to recognize eyelid injuries early and to institute aggressive management to prevent immediate and long-term consequences. Although injuries to the globe and loss of vision are very uncommon, inappropriate management of these injuries may lead to corneal and ocular problems that, in the majority of cases, are preventable if they were not part of the presenting burn. With appropriate and proactive management and judicious attention to fundamental principles, these injuries may be managed with confidence and excellent outcomes, even in the most severely injured patients.

Clinical Problem

Presentation

The periorbital region, in particular the eyelids, is a common site of involvement in facial burns. This area is of critical functional and esthetic importance. The loss of the eye itself is thankfully a rare sequela of thermal, and even caustic, injury. It is beyond the scope of this chapter to discuss the ocular management of facial burns. Suffice it to say that close collaboration and consultation from colleagues in ophthalmology are mandatory and will help ensure optimal care of these injuries in the acute and chronic stages of evaluation and management. The majority of this chapter will focus on secondary management of eyelid burns and the reconstruction options typically used in our practice.

Etiology

Thermal and caustic injuries will compromise the majority of pathology seen. Scald and flame burn injuries appear to be the most common thermal burns suffered in the periorbital area. Caustic burns from acid attacks are also common injuries seen, in particular in certain geographical distributions in the world, such as Africa and India. The highest at-risk populations include the elderly, those who are disabled, children, and those populations in high-prevalence areas of acid attacks, as retribution injury victims.

The release of contractures and placement of autografts have been and continue to be a mainstay of treatment. Today, we are fortunate to have learned much about burn scar biology and behavior and about how to use old and new methods to optimize management and outcomes. Many of the recommendations made herein are also steeped in decades of observation, experience, and fundamental principles that have allowed for excellent outcomes and that have limited additional morbidity in this area of reconstructive burn surgery.

Associated Conditions

Many of these injuries have low incidences of scleroconjunctival, corneal, or eyelid injuries that require more than conservative treatment. When injuries are more substantial and that is not the case, appropriate acute and chronic management of these patients will dictate short- and long-term outcomes. Corneal injury or scleroconjunctival irritation or exposure is best managed in close collaboration with an ophthalmologist.

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