Mascara: A Cause of Thermal Burn after Cautery for Eye Lid Lesion Excision; A Case Report

Abstract

IntroductionA surgical fire is a rare but potential risk in surgical practice. Fire has been recognised as a potential complication of surgery for many years [1]. Fire occurs when the three elements of the fire triad, fuel, oxidiser and ignition coincide. Surgical fires are unusual in the absence of an oxygen-enriched atmosphere. The ignition source is most commonly diathermy but lasers carry a relatively greater risk. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, and flammable drapes [2][3][4]6,10].The majority of fires occur during head and neck surgery. In ophthalmic practice the incidence of surgical fires reported is very rare despite the presence of oxygen and the use of electrocautery [12]. PurposeWe describe a case of surgical flash fire causing thermal burn of eye lashes, eyelid skin and eye brow hair in a patient who had some residual mascara on her lashes while cautery was applied for an eyelid lesion after excision in clinical setting and in the absence of oxygen rich environment. Case reportWe report a 38 year old lady who had a small papilloma on the right upper eyelid skin for which she underwent excision. Surgical techniqueThe area was exposed and cleaned with povidine iodine. After the iodine was wiped off the area was left to dry for a minute and a small forceps was used to lift the papilloma. A 15 degree blade was then used to cut it from its base. Disposable pencil cautery was used to stop the bleeding by applying it onto the base of the lesion. A sudden blue flame of fire then caught the eyelashes, swept through the skin and burnt the eye brow hair successively. It also caused the surgical gloves used by the surgeon to be burnt and to scald his finger tips underneath. Cautery was abandoned immediately.Cold water was applied to the area, antibiotic ointment was given and the patient was examined at the slit-lamp. No conjunctival, corneal or any other ocular injury was noted and the patient was reviewed after one week and then after one month. By then the burns had recovered and all lashes and brown hair had re-grown. DiscussionCautery can be applied in several clinical settings in order to ensure haemostasis after excision of small lesions. Surgical fires have been described in several occasions within the operating room and in an oxygen-rich environment. Several igniting factors have been described and review of surgical flammable materials and safety issues in the operating room can be found in literature [2]. DiscussionThe fire triangle is a useful construct that describes the three elements necessary for initiation of a fire i.e. heat, fuel and an oxidizer [5,6,8,9,11]. spark from electrosurgical unit usually acts as the heat source. Experimental studies have shown that hot wire cautery or diathermy generates enough heat to ignite all alcohol based antiseptics even if these contain as little as 20% alcohol [3]. Fuels are abundant in the operative field that include prep solutions, drapes, sponges, endotrach...

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“…From the earliest times, medical practitioners have sought divine help and support to aid them as they go about their busy rounds for screening [63]. Surgeons as well as the entire ophthalmic care team should be aware of this incident to try to minimize the risk of thermal injury by working in a make-up free ophthalmic field [64]. The simplicity and the speed of this screening method make it possible for the analyst to screen a large number of visual problems [65].…”