Thermal injuries of the cornea: Injury patterns and histopathology

Abstract

Purpose : Thermal injuries of the cornea are rarely encountered in burn unit patients; here we report a series of 10 patients treated over the last 3 years. Sloughed tissue was submitted for histology when available.

Methods : We identified the records of all patients treated for thermal injuries of the cornea from 2013-present. Demographics, injury characteristics, initial eye exam findings, photographs, treatment, eye outcome, and mortality were reviewed. Histology slides and pathology reports were reviewed if available. Data are presented as average +/- standard error.

Results : Ten patients sustained 17 corneal injuries at the time of burn injury. The average age was 21 +/-6 years. The average total body surface area burned was 48 +/- 6%. Four patients were injured in closed-space fires. All 4 sustained bilateral injuries comprising the entire corneal surface. Histology indicated the depth of the sloughed tissue varied between partial epithelial thickness to full-thickness epithelial and fragments of superficial stromal collagen. Three patients suffered flash/flame burns to the face, without closed-space fire. These 3 had unilateral corneal lesions located in the palpebral fissure. The final 3 patients demonstrated early, bilateral, inferior epithelial lesions which progressed despite treatment in 2. All 3 of these patients developed multi-organ failure, with 2 succumbing to their injuries.
Amniotic membrane coverage was used in 9 of 10 patients. Corneal healing was achieved with a single treatment in 4. Amnion was re-applied in 5 patients, with eventual re-epithelialization in 3. Two patients were refractory to amnion treatment; both had multi-organ failure. One developed descemetocele, and the ocular surface was stabilized via Gundersen flap. The other suffered corneal perforation. Both patients ultimately succumbed to their injuries.

Conclusions : To our knowledge, this is the largest series of acute corneal thermal injuries reported to date. Three patterns of injury are identified: complete bilateral injury of varying depth seen in closed space fires, unilateral interpalpebral focal lesions seen in flash thermal injury, and fulminant progression of an initial localized inferior epithelial injury seen in critically-ill patients with multi-organ failure. Overall, re-epithelialization was achieved in 7 of 9 patients treated with amnion, while failure was observed in 2 of the 3 patients with multi-organ failure.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.