A lateral tarsorrhaphy with forehead hitch to pre-empt and treat burns ectropion with a contextual review of burns ectropion management

Reconstruction of Bilateral Upper and Lower Eyelid Ectropion Caused by a Liquid Unblocker Chemical Burn

Liquid drain unblockers, although meant to be used by professionals with protective equipment, are sometimes used in the household without any precautions. This could lead to severe chemical burns, as in the case we present with severe eyelid ectropion. This study aims to stress the need for preventive measures regarding the use of chemicals and for close observation and timely surgical intervention in chemical burn patients to prevent and limit disfigurement. A 45-year-old woman was injured while using an unblocker (90% sulfuric acid) at home. Accidentally, a quantity of the liquid was spilled on her face. She was initially examined in ophthalmology emergencies because of the obvious ocular involvement, and the cutaneous component was underestimated. On the third post-burn day, she was referred as an outpatient to our clinic, and because of the soft consistency and patchy pattern of the burn, she was asked to revisit in a week. Unfortunately, she reappeared two months post-burn with severe ectropion of all four eyelids and a high risk of corneal abrasion, desiccation, and further damage to the already injured left eye as well as the right eye. She underwent three operations in six months and a fourth 15 months after the accident, with the release of the scarred eyelids with full-thickness skin grafts, Z-plasties, and V-Y plasties. After four operations and sessions of triamcinolone acetonide intralesional injection, the patient has a satisfactory eyelid position and function with adequate closure and scar maturation. Domestic use of strong industrial chemicals is dangerous, and public education for prevention is urgently needed. On the other hand, it is mandatory to follow up very closely with chemical burn patients to prevent severe sequelae, especially in the delicate and contraction-prone periocular and perioral areas. Reconstruction, in these cases, is a complex task. Often, several surgeries are needed to restore acceptable function and appearance. Burn disfigurement and self-stigma will follow the patients to some extent throughout their lives.