Periocular Facial Scald Burns in Children: Is Ophthalmology Consultation Necessary?
Konstantinos Spiliopoulos; Carson E. Clay; Omar Z. Ahmed; Jonathan Taylormoore; Bethany Karwoski; Randall S. Burd
Children’s National Medical Center
Introduction: Criteria that predict ocular injuries in children requiring treatment after periocular facial scald burns are not known. The purpose of this study was to evaluate the management of ocular injuries among children sustaining facial scald burns and to determine predictors of injuries requiring additional treatment.
Methods: Children treated at a burn center with periocular facial scald burns were identified. Patient and injury profiles were compared between those evaluated and not evaluated by ophthalmology. Univariate and multivariate analyses were used to determine factors associated with an ocular injury requiring treatment. Treatment differences before and after ophthalmology consultation were evaluated.
Results: Among 73 children with facial scald injuries, nine had ocular injury (corneal abrasion, conjunctivitis, scleral burn, or chemosis of the conjunctiva). Among 23 patients who received erythromycin ointment (the only prescribed treatment), only seven had a documented ocular injury. Children seen by an ophthalmologist (n=24) more often presented with (25.0% vs. 6.1%, p=0.05) and were treated for an ocular injury (58.3% vs. 14.3%, p<0.001). Only four patients had modification in their treatment plan after consultation, three of whom were started on treatment despite not having an ocular injury. Older age was the only predictor of an ocular injury requiring treatment (1.3 odds increase per year).
Discussion: Ocular injury after periocular facial scald burns is an infrequent finding. Ophthalmic antibiotic is an initial appropriate treatment in most symptomatic patients.
Conclusion: Among children with periocular facial scald burns, initial evaluation and treatment without ophthalmology consultation is appropriate. Ophthalmologic consultation may be limited to children with worsening symptoms or failure to improve.
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