Periorbital necrotising fasciitis

Abstract

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.

‘Stalled’ periocular necrotising fasciitis: early effective treatment or host genetic determinants?

“…3 Prompt antibiosis can reduce not only local tissue destruction-mediated by acute-phase cellular infiltration and release of lytic enzymes-but also the risk of bacteraemia and systemic organ failure. Aggressive surgical debridement can also prevent the subcutaneous extension of bacterial infection and accompanying tissue lysis.…”

“…1 NF is most common in the abdominal wall, perineum and extremities, with the least affected area being the cervico-facial region (o10% of all cases); 2 periorbital involvement is rare, 3 with associated mortality (14.4%) being markedly lower than for the disease elsewhere. 3 The most common causative bacteria have been grouped into type 1 (polymicrobial infections, consisting of a mixture of anaerobes, Gram-negative bacilli and enterococci) and type 2 (group A b-haemolytic Streptococcus with or without associated staphylococcal infection).…”

Fasciite nécrosante orbito-palpébrale, compliquant une pansinusite chez une patiente diabétique

“…Le processus touche essentiellement les extrémités, l'abdomen, le dos, les régions génitales et péri anales chez des patients de tout âge, sans prédilection de sexe ni de race [1][2][3]. La localisation orbito-palpébrale est rare : seuls 104 cas sont répertoriés de 1950 à 2010 dans une revue récente de la littérature [3].…”

“…Généralement, la fasciite nécrosante est due à un Streptocoque β hémolytique du groupe A seul dans 50% des cas ou associée au Staphylocoque Aureus dans 18 % [3]. Le diabète (notre cas), l artério sclérose, l alcoolisme, l immunosuppression, et l'utilisation d'anti-inflammatoires non stéroïdiens sont les principaux facteurs prédisposant [3][4][5].…”

“…Le diabète (notre cas), l artério sclérose, l alcoolisme, l immunosuppression, et l'utilisation d'anti-inflammatoires non stéroïdiens sont les principaux facteurs prédisposant [3][4][5]. Dans près d'un tiers des cas aucune cause évidente n'est retrouvée [1,3].…”