Hypochlorous Acid as an Adjunctive Treatment for Periocular Necrotizing Fasciitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Wound Care

Background:

• Periorbital necrotizing fasciitis (PONF) is a severe infection requiring aggressive treatment.
• Traditional treatments often involve antibiotics and extensive tissue debridement, risking significant functional and aesthetic compromise.

Purpose of the Study:

• To evaluate the efficacy of high-dose intravenous antibiotics combined with dilute, pure hypochlorous acid (HOCl) irrigation and topical spray for PONF.
• To assess outcomes without the need for tissue debridement in the periocular area.

Main Methods:

• A retrospective chart review of 6 patients with PONF treated with HOCl between May 2022 and May 2024.
• Primary outcomes included infection eradication, aesthetic results, and preservation of vision.
• Treatment outcomes were compared to literature data for traditional and conservative PONF management.

Main Results:

• All 6 patients received dilute, pure HOCl (0.033%) without periocular debridement.
• The most common pathogen was Streptococcus pyogenes (80%).
• All patients achieved infection resolution with minimal sequelae, preserved vision, and required no enucleation or exenteration. No deaths occurred.

Conclusions:

• Dilute, pure HOCl irrigation and topical spray represent a simple, effective adjunctive treatment for PONF.
• This approach significantly reduces the need for debridement, leading to faster resolution and favorable aesthetic and functional outcomes.
• HOCl treatment favorably compares to traditional debridement methods and conservative antibiotic therapy in managing PONF.