Eye burns are real medical emergencies that result in a devastating loss of vision. Facial burns can also lead to blindness. Therefore, a patient with an eye burn needs immediate medical attention to prevent additional damage and vision impairment.
Generally, eye burns can be grouped as mild, moderate, or major. Minimal or mild burns are slight injuries that don't need major medical interventions. Moderate burns are deeper partial-thickness injuries that may heal gradually with medical treatment. Major eye burns are deep-partial or full-thickness wounds that need early surgical treatment with skin grafts.
The injury's degree and depth depend on the duration, heat exposure intensity and the thickness of the patient's skin layers. Eye tissues, including the eyelids, are thinner, leading to deeper injuries than similar heat exposure to skin elsewhere.
Also Known As
- Heat burn
- Heat eye burn
- Ocular thermal burn
- Heat burns in the eye
Heat eye burns may be categorized depending on the level, depth and severity of the wound, including damage to the underlying tissue:
- Epidermal burns - First-degree burns
- Partial-thickness burns - Second-degree burns
- Full-thickness burns - Third-degree burns
- Deep burns - Fourth-degree burns
Causes & Risk Factors
Fire/flame and scald are the most common causes of heat eye burn injuries. Hot water scalding injuries being a particular problem in children.
Risk factors include hazardous occupation/work.
Signs & Symptoms
Heat burn injuries can result in:
- Eye Pain
- Eye twitching
- Eye discharge
- Increased sensitivity to light
- Singed or scorched eyelashes
- Reduced, double, or blurred vision
- A sensation of a foreign body or grain in the eye
The ophthalmologist will evaluate and document the degree of the injury in the facial area, eyelid, eyelid margin and eye surface as soon as possible. The eye surface examination includes the assessment of the cornea, bulbar and tarsal conjunctiva. S/he may also check for foreign bodies and particulate material on the eye surface, in the eye or the eye socket, especially in high velocity or blast injuries. S/he may order imaging tests for a definitive diagnosis.
The eye examination may be conducted in the surgeon's office, or emergency room under topical anesthetic before substantial eyelid and conjunctival edema prevent a thorough evaluation. The doctor needs to determine the integrity of the surface of the cornea. Therefore, s/he may need to conduct a proper corneal evaluation using cobalt blue light and fluorescein strips in the burn unit or emergency room.
Management of heat burns may include:
After the accident, the patient should rinse the eye out as soon as possible to bring down the temperature. Taking quick steps to run cool water over the eye for 15 to 20 minutes improves the chances of complete healing. One can also use the liquid from an eyewash kit or saline solution instead. It's essential to remember that keeping the eyes closed due to the pain can worsen the damage. Patients who wear contact lenses should remove them while the water is running over the eyes. One shouldn't wait to remove the contacts first.
The doctor will work quickly to cool the eye tissue by rinsing it out with water and may also place a cold compress on the eye. The doctor can prescribe medication to relieve the pain and antibiotic eye drops and ointments to prevent infection. S/he may also prescribe lubricating eye drops (artificial tears) or ointment to keep the eye(s) moist during the healing period.
S/he will remove any scorched or singed eyelashes to prevent the risk of char getting into the eye and prolong discomfort on the eye surface. The initial treatment also involves frequent evaluation of both the eyelids and the eyeballs. Generally, clear occlusive dressing with sufficient lubricant gels is useful in cases where there is lagophthalmos with a severe eyelid skin burn. At times, a suture tarsorrhaphy is effective in assisting closure.
Previously, skin grafting was often performed after the cicatricial changes stabilized. The early use of an amniotic membrane, full-thickness skin grafts, and different kinds of flaps can effectively lower eye morbidity in some patients.
Long term management may include surgical or laser scar revision and repair of:
- Eyebrow deformities
- Canalicular obstruction
- Retraction with skin grafts
- Medial canthal deformities
- Palpebral aperture stenosis
Prognosis & Long-Term Outlook
The prognosis of an eye burn depends on the depth of the wound. The outcome is good in mild to moderate cases, while severe cases may need substantial intervention, including rehabilitation services or corneal transplant. The main concerns with eye burns are cosmesis and final visual acuity. Generally, heat burns have good visual outcomes and with prompt treatment and ophthalmologic intervention.
Prevention & Follow Up
People should use protective eye gear when outdoors or performing hazardous work, such as welding and handling explosives, boilers and steam vessels, etc. Parents should keep children away from the kitchen and other places where they are vulnerable to hot water and other types of injuries.
Follow‐up treatment within 24 hours is mandatory. Severe eye burns, i.e., third- and fourth-degree burns, may be handled in the hospital on an in-patient basis. Often, they are difficult to treat, and the course of healing can last several months.