Periorbital necrotising fasciitis: Rare cases with complex diagnosis and surgical treatment-case series

Abstract

Introduction: Necrotising fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. The infection can follow local blunt trauma, penetrating injuries and facial surgery, but in some cases no cause is 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 is mainly β-haemolytic Streptococcus alone, occasionally in combination with staphylococcus aureus. 

Cases report: We present two cases of NF. A 33-year-old male patient, a victim of accidental glass prick from a glass window while in a vehicle, with a delayed diagnosis of periocular necrotising fasciitis. Additionally, we report a case of a 1-year-old female patient, a victim of acute dacryocystitis, which complicated to deep tissue necrosis with medial canthal defect and lacrimal drainage system necrosis. Both patients underwent surgical and medical treatment.

The patient’s survival outcomes were favorable; the sequelae were not disabling. The rarity of such cases and the peculiarities of the cases dictate that prompt clinical examination and aggressive surgical and medical management are key to preventing NF. 

Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localisations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimising significant disabilities.