Acute surgical vs non-surgical management for ocular and peri-ocular burns: a systematic review and meta-analysis

Abstract

Background Burn-related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve functional and cosmetic outcomes, and correct complications following poor acute phase management. The objective of this article was to evaluate if non-surgical or surgical interventions are best for acute management of ocular and/or peri-ocular burns. Methods This systematic review and meta-analysis compared 272 surgical to 535 non-surgical interventions within 1 month of patients suffering burn-related injuries to 465 eyes, 253 eyelids, 90 eyelashes, and 0 eyebrows and evaluated associated outcomes and complications. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes, and complications were recorded. Results Eight of the 14,927 studies queried for this study were eligible for the systematic review and meta-analysis, with results from 33 of the possible 58 outcomes and complications using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. Surgery was associated with standard mean differences (SMD) 0.44 greater visual acuity on follow-up, SMD 1.63 mm shorter epithelial defect diameters on follow-up, SMD 1.55 mm greater changes in epithelial diameters from baseline, SMD 1.17 mm2 smaller epithelial defect areas on follow-up, SMD 1.37 mm2 greater changes in epithelial defect areas from baseline, risk ratios (RR) 1.22 greater numbers of healed epithelial defects, RR 11.17 more keratitis infections, and a 2.2 greater reduction in limbal ischemia compared to no surgical intervention. Conclusions This systematic review and meta-analysis found that compared to non-surgical interventions, acute surgical interventions for ocular, eyelid, and/or eyelash burns were found to have greater visual acuity on follow-up, shorter epithelial defect diameters on follow-up, greater changes in epithelial diameters from baseline, smaller epithelial defect areas on follow-up, greater changes in epithelial defect areas from baseline, greater numbers of healed epithelial defects, more keratitis infections, and a greater reduction in limbal ischemia, possibility preventing the need of a future limbal stem cell transplantation.

Global Burn Registry Perspective on Head and Neck Burns

“…10,[38][39][40] Ocular burns were the least common site for head and neck burns, yet they were the most lethal. Morbidity after ocular burns has been well established, 41,42 but this is the first study to demonstrate the prognostic value of ocular burn injury. Industry adherence to safety recommendations and regular use of eye protection are fundamental to minimizing the incidence of these burns.…”

Management of multi-surface ocular burns caused by molten iron

“…Hence, burns initially presenting as dermal/partial thickness may progress to full-thickness injury if appropriate and timely measures are not taken [ 4 ]. Although the evidence in the literature suggests a waiting period of at least three weeks from injury to undertake a surgical lid repair, some evidence also outlines the benefit of early lid repair (within seven days of injury) to reduce corneal exposure and superadded purulent keratitis [ 13 , 14 ]. In this case, repair using a Tenzel semicircular advancement flap was performed at two weeks post-injury due to non-resolving lid ischemia and preventing further progression of the lid notching.…”

Posterior lamellar tarsorrhaphy in the early treatment of severe eyelid trauma/burns

“…[4] Studies show that surgeons prefer to perform primary reconstruction with grafts and/or fl aps in burns/trauma patients, instead of tarsorrhaphy. [1,5,6] In most of these reports, the intervention was performed within 2-4 weeks of presentation. [6] The main reason for avoidance of permanent tarsorrhaphy was that the procedure can lead to eyelid margin irregularity, trichiasis, entropion, etc.…”

“…[1,5,6] In most of these reports, the intervention was performed within 2-4 weeks of presentation. [6] The main reason for avoidance of permanent tarsorrhaphy was that the procedure can lead to eyelid margin irregularity, trichiasis, entropion, etc. In contrast, Frank et al [1] mentioned the use of tarsorrhaphy in some unavoidable situations with severe eyelid damage.…”