Acute Management of Eyelid Burns and Prevention of Exposure Keratopathy: A Critical Review

Abstract

Eyelid burns are a clinically significant subset of facial burns and may lead to permanent visual morbidity when corneal protection is not prioritised during acute care. The eyelids maintain ocular surface integrity through blinking, tear film redistribution and mechanical shielding; these functions may be rapidly impaired by thermal, chemical, electrical or radiation injury. Resultant lagophthalmos, cicatricial ectropion and eyelid retraction can initiate exposure keratopathy, which ranges from superficial punctate epithelial damage to persistent epithelial defects, stromal ulceration, secondary infective keratitis and corneal perforation. This critical review synthesises peer-reviewed literature published between 2009 and 2026, with supplementary inclusion of landmark earlier studies where clinically relevant, to examine acute management strategies for eyelid burns with particular emphasis on the prevention of exposure keratopathy. The review considers mechanisms of injury, clinical classification, acute ophthalmic assessment, medical corneal protection, surgical interventions and aetiology-specific considerations. The evidence supports prompt irrigation and decontamination for chemical burns, early ophthalmic assessment, frequent fluorescein-based monitoring, intensive preservative-free lubrication, moisture chamber protection and escalation to bandage contact lenses, temporary tarsorrhaphy or amniotic membrane transplantation when clinically indicated. Deep partial-thickness and full-thickness eyelid burns require early reconstructive planning to reduce cicatricial malposition and subsequent corneal exposure. The manuscript further emphasises the importance of multidisciplinary coordination between burn surgeons, plastic surgeons, ophthalmologists and nursing teams. Although available evidence supports a structured and proactive approach, practice remains variable across burn units. Standardised ocular assessment and protection protocols, together with prospective multicentre research, are needed to reduce avoidable corneal morbidity after eyelid burns worldwide.