Facial necrotizing fasciitis following acute dacryocystitis

Lin, Pei Wen; Lin, Huang‐Chi

doi:10.1016/s0002-9394(03)00089-8

Cited by 18 publications

(8 citation statements)

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“…Infections such as acute dacryocystitis (Lin & Lin 2003; Roos et al. 2011; Watson & Sloan 2003; our unreported case 1 in Table 3), sinus infections (Luksich et al.…”

Section: Resultsmentioning

confidence: 99%

Periorbital necrotizing fasciitis - a review

2012

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. Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft‐tissue defects affecting function and cosmesis.

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“…Infections such as acute dacryocystitis (Lin & Lin 2003; Roos et al. 2011; Watson & Sloan 2003; our unreported case 1 in Table 3), sinus infections (Luksich et al.…”

Section: Resultsmentioning

confidence: 99%

Periorbital necrotizing fasciitis - a review

2012

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“…Although there are known risk factors (table 2), mainly related to mild (alcoholism,6 17 20 23 26 29 32 35 36 44 45 52 53 55 64 70 diabetes,6 10 11 15 22 50 51 58 68 rheumatological disease,18 45 48 chronic corticosteroid use and a combination of these conditions25 40 55) and severe (chemotherapy for malignancies and lymphoproliferative disorders)28 41 48 62 67 immune suppression, about one-half of the patients with reported NF were previously healthy 4 6–8 12 13 16 19 21 23 24 27 30–35 37–39 41–43 45–47 49 54–57 60 63 66 69 72–74. Haematological malignancy itself (our case) and neutropenia caused by chemotherapy may be an important predisposing factor for NF, because of the reduction in the number and activity of effector cells such as neutrophils and monocytes, and disruption of the barrier function of mucosal membranes.…”

Section: Resultsmentioning

confidence: 99%

“…Haematological malignancy itself (our case) and neutropenia caused by chemotherapy may be an important predisposing factor for NF, because of the reduction in the number and activity of effector cells such as neutrophils and monocytes, and disruption of the barrier function of mucosal membranes. The infection may follow (table 2) local blunt trauma,6 14 15 17 21 27 29 30 33 34 42 49 53 55 57 73 or any condition in which the integrity of eyelid integument is compromised by abrasion, laceration or penetrating injuries 4 6–8 11 20 23–26 31 32 35–37 45 55 58 64 74. NF has also been reported following blepharoplasty,43 47 51 56 dacryocystorhinostomy,48 surgical biopsy and excision,12 28 35 42 61 69 and self-puncture of a hordeolum externum.…”

Section: Resultsmentioning

confidence: 99%

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Periorbital necrotising fasciitis

Lazzeri

Figus

et al. 2009

British Journal of Ophthalmology

141

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Necrotising fasciitis involving the periorbita is a devastating infection. Potential outcomes range from severe disfigurement, loss of the eye and even to death. Early recognition is critical, although its initially non-distinctive appearance frequently delays diagnosis and treatment. Herein, the authors have performed a systematic review of previously published cases including clinical features, diagnoses and differential diagnoses, pathological characteristics and management. Periorbital necrotising fasciitis is seen mainly in adults with a female predominance (54%); about one-half (47%) of the patients were previously healthy. The infection can follow local blunt trauma (17%), penetrating injuries (22%) and face surgery (11%), but in about one-third of cases (28%) no cause was identified. Non-specific erythema and localised painful swelling of the eyelids characterise the earliest manifestation of the disease, followed by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection was mainly β-haemolytic Streptococcus alone (50%), occasionally in combination with Staphylococcus aureus (18%). The overall mortality rate was 14.42%. The main risk factor for mortality was the type of causative organism, since all reported cases of death were caused by β-haemolytic Streptococcus alone or associated with other organisms. Unlike necrotising fasciitis affecting other body sites, there was not a strong correlation with age >50 years or the presence of associated chronic illness. Management of periorbital necrotising fasciitis is then based on early distinction of symptoms and signs and aggressive multidisciplinary treatment. Thus, the delay between initial debridement and initiating parenteral broad-spectrum antibiotic therapy should be considered the most critical factor influencing morbidity and mortality.

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“…nach intravitrealer Injektion eines Dexamethason-Implantats [5]. In einigen Fällen sind jedoch keinerlei Verletzung, stumpfes Trauma oder vorher bestehende Infektion festzustellen [17,21]. Nach dem Eintritt der Erreger ins Gewebe breitet sich die Infektion im Verlauf subkutaner Faszien in einem Zeitraum von 2 bis 4 Tagen rapide aus, wobei sich die Infektion im Bereich der Faszie meist weiter ausdehnt als die äußerlichen Veränderungen vermuten lassen [21].…”

Section: Periokuläre Nekrotisierende Fasziitis -Fallbericht Und üBerbunclassified