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Periocular necrotising fasciitis: a multicentre case series
  1. Saul N Rajak1,2,3,
  2. Edwin C Figueira3,
  3. Anjana S Haridas4,
  4. Khami Satchi5,
  5. Jimmy M Uddin1,
  6. Alan A McNab5,
  7. Cornelius Rene6,
  8. Timothy J Sullivan4,
  9. Geoffrey E Rose1,
  10. Dinesh Selva3
  1. 1Adnexal, Moorfields Eye Hospital, London, UK
  2. 2International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
  3. 3South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
  4. 4Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
  5. 5Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
  6. 6Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
  1. Correspondence to Dr Saul N Rajak, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia; saul.rajak{at}Lshtm.ac.uk

Abstract

Introduction Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone.

Results Twenty-nine patients (20 men; 69%) with PONF were identified and followed up for between 2 months and 10 years (median 57, mean 52.6 months) between 1990 and 2013. Conditions associated with chronic immunocompromise were present in 16/29 (55%). Twenty-one (75%) recalled minor periocular trauma or an infected lesion, two having been assaulted by the same assailant. Systemic shock occurred in 6/29 (21%) patients and 1 died. Group A, β-haemolytic Streptococcus was the most common bacterium identified (25/29, 86%). Intravenous antibiotics were used in all patients, and up to five tissue debridements were required to control the disease in 23/29 (74%); reconstructive surgery was required in 12/29 (41%) patients. One patient died from the disease and visual loss occurred in four eyes of four patients (14%).

Conclusions PONF has a better prognosis than disease elsewhere in the body, but is still associated with significant risk of visual loss and a small risk of death. Intravenous antibiotic treatment with cautious observation may be reasonable in selected patients with a low threshold for debridement.

  • Eye Lids
  • Infection

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Footnotes

  • Contributors SNR: conception and design of work, acquisition of data, analysis of data, interpretation of data, drafting of work, final approval of published version and agreement of accountability for all aspects of the work. ECF, ASH, KS, JMU, AAM, CR, TJS: design of work, acquisition of data, revising of work, final approval of published version and agreement of accountability for all aspects of the work. GER and DS: conception and design of work, acquisition of data, revising of work, final approval of published version and agreement of accountability for all aspects of the work.

  • Funding GER acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was received from the Royal Adelaide Hospital Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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