ABSTRACT
Necrotizing fasciitis is a rare, rapidly progressive severe bacterial soft tissue infection with a high mortality rate. While necrotizing fasciitis classically involves the trunk, groin/perineum, lower limbs, and postoperative wound sites, primary involvement of the eyelids is a rare but well known entity. We present a 33-year-old female patient who developed periocular necrotizing fasciitis after local retrobulbar anesthesia injection and facial block for cataract surgery in the left eye and canthotomy/cantholysis for treatment of moderate retrobulbar hemorrhage in the same eye. Surgical debridement was done and necrotic foul-smelling eyelid and deep orbital tissues were removed, and culture grew Staphylococcus aureus. Despite initial surgical debridement and intravenous antibiotic therapy, the disease progressed rapidly; orbital exenteration was considered, but the patient declined the surgery and self-discharged. Periocular necrotizing fasciitis remains predominantly a clinical diagnosis, and is often missed early in its presentation because of the difficulty in distinguishing it from other common soft tissue infections, especially in the presence of surgical wounds and retrobulbar hemorrhage. A high index of suspicion, early recognition, and prompt therapeutic interventions are indispensable for optimal visual outcome and patient survival.
ABSTRACT
PURPOSE: Necrotizing fasciitis is an uncommon soft tissue infection which spreads rapidly along subcutaneous fascial planes and produces overlying skin necrosis. We report a case of eyelid necrosis and periorbital necrotizing fasciitis. METHODS: A 64-year-old, previously healthy, male visited the emergency room complaining of acute facial edema. He had been using an ointment for itchy scalp lesion due to hair dye, and had multiple mosquito bites on his forehead. He took NSAIDs before the day of visit for headache. Physical examination showed erythematous swelling of soft tissue and tense fluctuant bullae on eyelid and periorbital area. On the 6th day of hospitalization bullae ruptured, and purplish discoloration and necrosis were noticed. RESULTS: Parenteral antibiotics and surgical debridement were applied. Wound cultures were positive for Staphylococcus aureus resistant to methicillin. Histology of the debrided tissue showed necrotizing inflammation. The full-thickness skin graft was performed over the exposed pretarsal and preseptal orbicularis muscle of the right eyelid. The skin defects were healed with the recovery of adequate eyelid function. CONCLUSIONS: We achieved satisfactory results with proper diagnosis and management such as parenteral antibiotics and surgical debridement in a case with eyelid and periorbital necrotizing fasciitis.
