A Case of Eyelid Necrosis and Periorbital Necrotizing Fasciitis

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.