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Periorbital necrotising fasciitis
  1. Davide Lazzeri1,
  2. Stefano Lazzeri2,
  3. Michele Figus2,
  4. Carlo Tascini3,
  5. Guido Bocci4,
  6. Livio Colizzi1,
  7. Giordano Giannotti1,
  8. Fulvio Lorenzetti1,
  9. Daniele Gandini1,
  10. Romano Danesi4,
  11. Francesco Menichetti3,
  12. Mario Del Tacca5,
  13. Marco Nardi2,
  14. Marcello Pantaloni1
  1. 1Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy
  2. 2Ophthalmology Unit, Department of Internal Medicine, University Hospital of Pisa, Italy
  3. 3Infectious Diseases Unit, Hospital of Pisa, Italy
  4. 4Division of Pharmacology and Chemotherapy, Department of Internal Medicine, University Hospital of Pisa, Italy
  5. 5Clinical Pharmacology Centre for Drug Experimentation, Department of Internal Medicine, University Hospital of Pisa, Italy
  1. Correspondence to Dr Davide Lazzeri, Operative Unit of Plastic and Reconstructive Surgery, Hospital of Pisa, Via Paradisa 2, Cisanello – 56100 Pisa, Italy; davidelazzeri{at}


Necrotising fasciitis involving the periorbita is a devastating infection. Potential outcomes range from severe disfigurement, loss of the eye and even to death. Early recognition is critical, although its initially non-distinctive 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, pathological characteristics and management. Periorbital necrotising fasciitis is seen mainly in adults with a female predominance (54%); about one-half (47%) of the patients were previously healthy. The infection can follow local blunt trauma (17%), penetrating injuries (22%) and face surgery (11%), but in about one-third of cases (28%) no cause was identified. Non-specific erythema and localised painful swelling of the eyelids characterise the earliest manifestation of the disease, followed by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection was mainly β-haemolytic Streptococcus alone (50%), occasionally in combination with Staphylococcus aureus (18%). The overall mortality rate was 14.42%. The main risk factor for mortality was the type of causative organism, since all reported cases of death were caused by β-haemolytic Streptococcus alone or associated with other organisms. Unlike necrotising fasciitis affecting other body sites, there was not a strong correlation with age >50 years or the presence of associated chronic illness. Management of periorbital necrotising 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.

  • Periorbital necrotising fasciitis
  • eyelid necrosis
  • review
  • fasciitis

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  • Funding None.

  • Competing interests None.

  • Patient consent Obtained.

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