Periocular Necrotizing Fasciitis Causing Posterior Orbitopathy and Vision Loss: How to Manage?

Area of Science:

• Ophthalmology
• Infectious Diseases
• Plastic Surgery

Background:

• Necrotizing fasciitis (NF) is a severe bacterial infection characterized by rapid progression and tissue necrosis.
• Periorbital NF, an infection affecting the tissues around the eye, can potentially spread into the deeper orbital structures.
• Accurate assessment of infection extent is vital for surgical planning, particularly debridement.

Observation:

• A 70-year-old diabetic male presented with periorbital NF following minor trauma, exhibiting a necrotic wound and severe pain.
• Clinical examination revealed NF involvement of the eyelids and surrounding facial regions, with signs suggestive of deep orbital compromise including proptosis and ophthalmoplegia.
• Computed tomography (CT) confirmed soft tissue abnormalities within the anterior orbit.

Findings:

• The patient's condition, including central retinal artery occlusion, suggested deep orbital involvement, possibly due to bacterial toxins causing remote vascular thrombi.
• Successful treatment involved subcutaneous debridement, antibiotics, and metabolic support, highlighting a less invasive approach.
• Periorbital NF can mimic posterior orbital cellulitis, necessitating careful differentiation from true orbital invasion.

Implications:

• Distinguishing periorbital NF with orbital symptoms from direct bacterial invasion of the posterior orbit is critical for appropriate management.
• Aggressive surgical interventions like exenteration may be avoided if the condition is managed effectively with debridement and antibiotherapy.
• This case underscores the importance of recognizing potential orbital complications in periorbital NF and considering non-invasive treatments when feasible.