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Periorbital Necrotizing Fasciitis
  1. Davide Lazzeri1,*,
  2. Stefano Lazzeri2,
  3. Michele Figus2,
  4. Carlo Tascini3,
  5. Guido Bocci4,
  6. Livio Colizzi5,
  7. Giordano Giannotti1,
  8. Fulvio Lorenzetti1,
  9. Daniele Gandini1,
  10. Romano Danesi4,
  11. Francesco Menichetti3,
  12. Mario Del Tacca4,
  13. Marco Nardi2,
  14. Marcello Pantaloni1
  1. 1 Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy;
  2. 2 Ophthalmology Unit, University Hospital of Pisa, Italy;
  3. 3 Infectious Diseases Unit, Hospital of Pisa, Italy;
  4. 4 Division of Pharmacology and Chemotherapy, Department of Internal Medicine, Univ. Hospital of Pisa, Italy;
  5. 5 Reconstructive Surgery Unit, Hospital of Pisa, Italy
  1. Correspondence to: Davide Lazzeri, Plastic and Reconstructive Surgery Unit, via Paradisa 2, Cisanello, Pisa, 56100, Italy; davidelazzeri{at}gmail.com

Abstract

Necrotizing fasciitis involving the periorbita is a devastating infection which potential outcomes range from severe disfigurement, loss of the eye, and even to death. Early recognition is critical though its initially nondistinctive 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, pathologic characteristics, and management. Periorbital necrotizing fasciitis is seen mainly in adults with a female predominance (54%); about half (47%) of the patients are previously healthy. The infection may follow local blunt trauma (17%), as well as penetrating injuries (22%) and face surgery (11%), whereas in about one-third of cases (28%) no cause is identified. Nonspecific erythema and localized painful swelling of the eyelids characterize the earliest manifestation of the disease, ensued by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection is mainly β-hemolytic Streptococcus alone (50%), occasionally in combination with Staphylococcus Aureus (18%). Mortality from this disease reveals an overall rate of 14.42%. The main risk factor for mortality is the type of causative organism since all reported cases of death were caused by β-hemolytic Streptococcus alone or associated with other organisms. Unlike necrotizing fasciitis affecting other body site, there is not a strong correlation with age greater than 50 years or the presence of associated chronic illness. Management of periorbital necrotizing 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.

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