Batsman Burns was positioned at short leg as the tourists attempted to break through the Sri Lankan middle order in Galle.
But the 28-year-old was laid flat out after he was struck by a powerful pull from Niroshan Dickwella off Moeen Ali.
The ball looked to have struck him on the back of his head, and though he was wearing a helmet the Surry left-hander was clearly in pain by the shuddering impact.
Medics rushed out to the middle to tend to Burns as his team-mates and the Sri Lankan batsmen looked on in concern.
It eventually emerged the back had struck him at the base of the neck, just above the shoulder blades.
And with treatment going on for some time to check up on the health of the England star, the umpires took the decision to take the players off for an early tea.
The medical team took their time working on Burns, checking to see if there were any serious issues as a result of the blow.
After more than five minutes of treatment it was a relief to see Burns sit up and talking to his team-mates.
And he was able to regain his feet and walk slowly to the boundary after being given the all-clear following the initial scare.
But when the players re-emerged for the start of the evening session, Burns was kept inside the dressing room and replaced by sub fielder Joe Denley.
That saw Keaton Jennings switched to take over at short-leg – and from the first delivery after tea he took a catch off Moeen to dismiss Angelo Mathews.
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