Necrotising fasciitis of the eyelid with toxic shock due to Pseudomonas aeruginosa.

Necrotising fasciitis is a rare and rapidly spreading soft tissue infection characterised by widespread necrosis of the superficial fascia and usually occurring in the limbs and the abdominal wall. Periocular necrotising fasciitis is unusual due to the excellent blood supply of the facial region. The usual pathogens are Group A beta-haemolytic Streptococcus and Staphylococcus aureus. We report a case of Pseudomonas necrotising fasciitis of the eyelid with septic shock, initially diagnosed as hordeolum in a young immunocompromised Chinese woman. Early recognition of the condition, followed by timely intervention with surgical debridement and intensive intravenous antibiotic treatment led to a favourable prognosis. It is important for general physicians to recognise the cardinal signs of necrotising fasciitis, as early treatment with timely surgical debridement and supportive medical therapy is the mainstay to successful management.

Charles Bonnet syndrome in Asian patients in a tertiary ophthalmic centre.

AIMS: To describe the epidemiology of Charles Bonnet syndrome (CBS) among patients in an Asian tertiary ophthalmic centre and to describe the characteristics of the hallucinations experienced. METHODS: 1077 consecutive patients aged 50 years and above were asked a standardised question to determine if they had ever experienced formed visual hallucinations. All patients who experienced these symptoms were further interviewed using a detailed, standardised questionnaire to ascertain if they met the diagnostic criteria established for CBS. RESULTS: There were 491 men (45.6%) and 586 women (54.4%). The best corrected visual acuity ranged from 20/20 to light perception in the better seeing eye and from 20/20 to no light perception in the worse seeing eye. Four patients (0.4%) were diagnosed with CBS; two men and two women. There were two Chinese and two Indians. The average age of the CBS patients was 76.3 years (range 65-90 years). Two patients had cataracts, one had glaucoma, and one had both cataracts and glaucoma. A wide variety of visual hallucinations were reported. Three out of four patients experienced a negative reaction to their hallucinations. Only one patient had discussed his symptoms with a doctor. CONCLUSIONS: This is the first report on the epidemiology of CBS in Asian patients. The prevalence rate of CBS (0.4%) is slightly lower than in comparable studies in non-Asian populations. The nature of the hallucinations experienced were similar to those previously reported.