Thermal burns: the management of thermal burns of the lids and globes.

Our experience with 40 patients with eyelid and globe burns is reviewed. Initial emphasis should be placed on close monitoring, particularly of partially alert patients, debridement and treatment of corneal exposure with artificial tears and scleral shells when needed. The use of soft contact lenses in 2 patients with exposure was unsuccessful. Surgical treatment should be initiated when corneal exposure fails to respond to medical therapy. It is advisable to wait for the end stage of scarring so as to optimize chances for a single definitive correction. The use of retroauricular, supraclavicular or inner arm skin for grafting whenever possible is advised. The use of Frost sutures, tie-on dressings, and separate operations for upper and lower lids is recommended. Superficial wound sepsis is not a contraindication to grafting. Preoperative systemic or topical antibiotics do not seem to affect the outcome of the graft.