Cicatricial, postburn ectropion and exposure keratitis

Exposure keratitis can lead to infectious keratitis, corneal perforation, blindness and disfigurement. Chronic exposure of the cornea can occur following facial burns that cause eyelid ectropion. This complication can be difficult to diagnose in the unconscious patient. Five patients have undergone lid ectropion release to 11 eyelids in the early postburn period over the past 5 years. One patient required repeat release. Full-thickness skin grafts were used for the lower eyelid and no graft failure occurred. Operations were performed between 30-50 days postburn. Plastic wrap was used in one patient as a temporary dressing to maintain corneal hydration until surgery could be performed. All the patients were noted to have exposure keratitis on ophthalmological review. Patients most at risk are those with large area burns that include the face, who require prolonged intensive care support. It is important to look out for the development of eyelid ectropion, which should be corrected when first diagnosed to prevent disabling, sight-threatening eye injury.