Dressing ignition and facial burns following orbital exenteration

A 49-year-old woman with type II diabetes mellitus and a history of smoking underwent partial eyelid-sparing exenteration of the right orbit and antifungal therapy for zygomycosis. The medial orbital wall healed with a 7-mm fistula to the ethmoid sinus and a moist granulating apex required daily dressing changes for several months. Eighteen weeks following surgery, the patient cleaned her face with an alcohol wipe and then lit a cigarette, igniting the dressing covering the exenterated eye socket. This caused severe burns to the periorbital regions of both eyes requiring debridement, allografts, and then split-thickness skin grafting. Factors predisposing to this unusual and serious complication of orbital exenteration are reviewed and the subjects of treatment and prevention are discussed. To our knowledge, this is the first reported case of dressing ignition with serious facial burns in a postexenteration patient.