Periorbital necrotizing fasciitis - a review

Abstract

. 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.

A case of acute periorbital necrotizing fasciitis

“…One case of Candida infection of the adnexa in a human immunodeficiency viruspositive patient has also been reported [3] . Apart from trauma, surgery near or at the periorbital area, immunosuppression and coexistent infection have also been reported as predisposing factors [1,5] . In about 27% of the cases, no predisposing factors are found [1] .…”

“…Apart from trauma, surgery near or at the periorbital area, immunosuppression and coexistent infection have also been reported as predisposing factors [1,5] . In about 27% of the cases, no predisposing factors are found [1] . In our case, the patient was considered immunocompromised because of his old age and multiple comorbidities.…”

“…All reported cases of death were found to be infected by GABHS alone or associated with other bacteria but none had fungal infection [1,5] . The significant predictors of mortality from NF are age (>50 years), immunosuppression and streptococcal toxic shock syndrome from GABHS [1] . Lazerri has emphasised the importance of the type of causative organism as the main risk factor for morbidity in patients with NF [5] .…”

“…NF is seldom reported to occur from fungal infection. There have been only two cases reported of fungal periorbital necrotizing fasciitis in an immunocompetent adult: one infected with Cryptococcus neoformans and the other with mixed infections of Candida and Aspergillus flavus [1,2] . There is also a case report regarding Candida infection of the eyelid in an immunocompromised patient [3] .…”

A Rare Case of Post-Insect Bite Periocular Necrotising Fasciitis: Successful Surgical Management

“…Periorbital NF have been reported to have better prognosis [1]. Studies published in past few years suggest that the mortality rate in case of periorbital NF ranges from 8.5% [3] to 12.5% [1]. Wladis et al reported a case series of seventeen patients with periorbital necrotizing fasciitis.…”