What are the concerning findings and management for burns near the eye 14 hours post-burn?

Red Flags and Management of Burns Near the Eye 14 Hours Post-Burn

Urgent ophthalmology consultation is essential for all burns near the eye to assess the extent of eyelid, conjunctival, and corneal involvement and prevent vision-threatening complications. 1

Concerning Findings to Monitor

• Eyelid retraction or inability to close the eye completely - This can lead to corneal exposure, ulceration, and permanent visual impairment 1, 2
• Conjunctival involvement - Manifesting as redness, chemosis (swelling), or pseudomembrane formation that requires removal 1
• Corneal epithelial defects - Detected using fluorescein staining, indicating damage to the protective surface of the eye 1, 3
• Formation of adhesions (symblepharon) - Abnormal bands of tissue forming between the eyelid and eyeball 1, 2
• Signs of infection - Including increased pain, purulent discharge, or worsening redness 1
• Increasing pressure or compartment syndrome - Particularly with circumferential burns that may require escharotomy 1, 4
• Visual changes - Including blurred vision, double vision, or decreased visual acuity 3

Immediate Management

• Ocular surface assessment - Using fluorescein eye drops to evaluate the extent of epithelial loss on both cornea and conjunctiva 1
• Gentle saline irrigation - To remove debris and any remaining chemical agents (if chemical burn) 1, 5
• Removal of pseudomembranes - Should be performed by an ophthalmologist to prevent adhesion formation 1
• Breaking of conjunctival adhesions - To prevent permanent scarring and functional limitations 1
• Prevention of corneal exposure - Especially important if the patient has eyelid retraction or inability to close the eye completely 1, 2

Treatment Protocol

For All Burns Near the Eye:

1. Apply white soft paraffin ointment to protect the cornea and prevent drying 1
2. Cover the eye with appropriate dressing - For significant skin sloughing of the eyelid, use plastic wrap applied with a thin layer of ointment or petroleum jelly 1
3. Monitor for signs of infection - Do not routinely administer prophylactic antibiotics unless infection is present 1
4. Pain management - Short-acting opioids and ketamine are effective for burn-related pain 1

For Chemical Burns:

• Immediate and copious irrigation with tap water or saline solution for at least 15-30 minutes 5, 6
• pH testing of the ocular surface to ensure neutralization of any chemical agents 3

Follow-up Care

• Daily ophthalmology review during the acute phase to assess healing and detect complications early 1
• Regular assessment of ocular surface integrity using fluorescein staining 1
• Monitoring of intraocular pressure as secondary glaucoma can develop 7
• Evaluation for surgical intervention if eyelid retraction causing corneal exposure occurs 2

When to Refer to a Burn Center

• Burns involving the face or eyes regardless of total body surface area 1, 4
• Any burn with visual impairment or concern for ocular damage 4
• Use telemedicine consultation with a burn specialist if immediate transfer is not possible 1, 4

Potential Complications

• Short-term: Corneal ulceration, infection, increased intraocular pressure 7, 3
• Long-term: Eyelid deformities (ectropion, entropion), symblepharon formation, dry eye syndrome, and vision loss 2, 3
• Psychological impact: Facial disfigurement can cause significant psychological distress requiring mental health support 4

Prevention of Complications

• Maintain ocular lubrication with preservative-free artificial tears and ointments 2
• Prevent mechanical trauma to the healing tissues 1
• Position the patient with head elevated to reduce periorbital edema 2
• Early surgical intervention for eyelid contractures causing exposure keratopathy 2