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Periorbital necrotizing fasciitis -- a review
Shantha Amrith1, Vijaya Hosdurga Pai, Wong Wan Ling
1Department of Ophthalmology, National University Health System, Singapore City, SingaporeDepartment of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, IndiaSingapore Eye Research Institute, Singapore National Eye Center, Singapore City, Singapore.
Abstract:
Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.
Insights
Periorbital necrotizing fasciitis (NF) is a rare but severe infection. Early recognition and treatment are crucial to prevent death, particularly from toxic shock syndrome, with mortality rates appearing to decline.
Area of Science:
- Infectious Diseases
- Ophthalmology
- Plastic Surgery
Background:
- Necrotizing fasciitis (NF) is a severe, rapidly progressing infection affecting superficial fascia and overlying skin.
- Periorbital NF, though uncommon due to the area's rich blood supply, can be fatal.
- This study reviews factors associated with mortality in periorbital NF.
Purpose of the Study:
- To systematically review and analyze factors linked to death in periorbital NF.
- To identify predisposing conditions, triggers, causative organisms, and the role of toxic shock.
- To assess the significance of risk factors contributing to mortality.
Main Methods:
- Systematic literature review of English-language periorbital NF cases over 20 years.
- Analysis of 94 patients from 61 reports, examining clinical data and outcomes.
- Statistical analysis to determine factors significantly associated with mortality.
Main Results:
- Group A beta-hemolytic Streptococcus was the most common organism (51.1%).
- Toxic shock syndrome (30.9%) and vision loss (13.8%) were significant complications.
- Mortality was 8.5%, with toxic shock, type 1 infections, facial involvement, and blindness significantly associated with death.
Conclusions:
- Mortality from periorbital NF appears to be decreasing.
- Early diagnosis and prompt treatment are vital to prevent fatal outcomes, especially toxic shock.
- Type 1 infections, though rare, pose a significant mortality risk in the periorbital region.
