Management of bilateral upper and lower eyelid retraction secondary to chemical burns: a case report
Author: Maria Mas Castells
Base Hospital / Institution: Chelsea and Westminster Hospital
ePoster presentation
Abstract ID: 24-365
Purpose
To describe the management of bilateral upper and lower eyelid retraction with subsequent lagophthalmos secondary to chemical burns.
Methods
An otherwise healthy 38-year-old male was assaulted with an unknown chemical agent splashed into this face.
Initial assessment identified a mixed-depth chemical burn involving the periocular area, bilateral upper and lower eyelids, midface and neck. Slit lamp exam revealed a bilateral moderate superficial keratopathy. There were no signs of limbal stem cell deficiency.
Skin contraction developed a few weeks following the burn leading to upper and lower eyelid retraction and causing blink lagophthalmos and exposure keratopathy (worse on the left). Left upper eyelid reconstruction was advised to prevent corneal damage.
Results
Left upper eyelid and medial canthus scar release with full thickness skin graft from the preclavicular area was performed uneventfully. Lagophthalmos, exposure keratopathy and ocular discomfort symptoms largely improved.
He is currently awaiting the same procedure on the right upper eyelid.
Bilateral lower eyelid ectropion is being managed with moisturising cream and upward massage.
Conclusion
Facial chemical burns can cause severe functional and cosmetic eyelid deformities, which can lead to sight-threatening complications such as exposure keratopathy and corneal ulceration.
Reconstruction of four-eyelid chemical burns involves several surgeries to restore acceptable function and appearance.
A step-wise approach should be followed, prioritising early upper eyelid reconstruction given the upper lid is the most crucial structure involved in corneal moisturising and ocular protection. Lower eyelid reconstruction can be dealt with at a later time as the lower eyelid plays a secondary role in the blinking mechanism.
This case report serves as an example of the timing in eyeild reconstruction following a chemical burn.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Richard | Scawn | Chelsea and Westminster Hospital |
| Manvi | Sobti | Chelsea and Westminster Hospital |
