Experience with burns of the eyes and lids in a regional burn unit.

During a 3-year period 1527 patients with burns were admitted to a regional burn unit in Augusta, Georgia. Two hundred thirty patients (15.06%) were referred for consultation by an ophthalmologist. Thirty-two patients had preexisting ophthalmic problems that were believed to warrant consultation. One hundred eighty-nine patients were seen because of facial burns. Of these, 143, or 9.36%, had burn injuries of the eyes or lids that required care. Lid involvement was encountered in 122 (7.98%) cases. In 78 cases lid involvement was bilateral (in the remainder, unilateral). In 61 cases thermal or chemical burns to the conjunctiva or lens were present. Skin grafts to the lids were required for acute care in 11 instances. Tarsorrhaphies were done in 11 instances. In one case the lids were essentially destroyed, and extensive reconstruction with flaps was needed. Late reconstruction with grafting of the lids was done in five cases. In three eyes (two patients) enucleation was eventually required. Ten patients without burns who had toxic epidermal necrolysis were also treated on the unit. Consultation with an ophthalmologist is believed to be important in patients with significant ocular or periocular injury. The importance of maintaining moisture to the globe is stressed.

Life-threatening complication of retrobulbar block. A hypothesis.

After routine retrobulbar injection of a 4-ml 1:1 mixture of 0.75% bupivacaine, and of 2% lidocaine and one ampule of hyaluronidase for cataract extraction, the patient sustained bilateral opthalmoplegia, blindness, central respiratory arrest, and loss of consciousness. Neurologic examination shortly thereafter suggests that this may be a result of accidental subarachnoid injection. Prompt recognition and treatment reversed a life-threatening situation.