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Updated: Jun 28, 2026

Intravitreal Injection and Quantitation of Infection Parameters in a Mouse Model of Bacterial Endophthalmitis

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How Does the Laboratory Risk Indicator for Necrotizing Fasciitis Score Compare to Previously Validated Models in

Laura E Ramirez¹, Andrew Schwartz¹, Edward J Wladis^1,2

¹Department of Ophthalmology, Lions Eye Institute.

Ophthalmic Plastic and Reconstructive Surgery

|February 16, 2026

Summary

Biomarkers like neutrophil-to-lymphocyte ratio can help differentiate orbital necrotizing fasciitis (NF) from orbital cellulitis (OC). The Laboratory Risk Indicator for NF score was not effective in distinguishing these orbital infections.

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Three-Dimensional Reconstruction of Orbital Fractures

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Three-Dimensional Reconstruction of Orbital Fractures

Three-Dimensional Reconstruction of Orbital Fractures

Published on: May 16, 2025

Area of Science:

Ophthalmology
Infectious Diseases
Laboratory Medicine

Background:

Orbital infectious processes, such as necrotizing fasciitis (NF) and orbital cellulitis (OC), present with similar symptoms, necessitating accurate diagnostic tools.
Timely differentiation between NF and OC is crucial for effective treatment and preventing severe complications.

Purpose of the Study:

To evaluate the efficacy of the Laboratory Risk Indicator for NF score and other hematologic biomarkers in distinguishing between orbital NF and OC.
To identify reliable biomarkers for rapid diagnosis in cases of orbital infections.

Main Methods:

Calculation of Laboratory Risk Indicator for NF scores, neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-platelet ratio (NPR) from initial blood draws.
Statistical analysis using Mann-Whitney tests and receiver operating characteristic (ROC) curves to compare biomarker performance.

Main Results:

Neutrophil-to-lymphocyte ratio (NLR), derived NLR, and neutrophil-to-platelet ratio (NPR) were significantly higher in patients with NF compared to OC (p < 0.05).
The Laboratory Risk Indicator for NF score, monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) did not show statistically significant differences between the two groups.
Neutrophil-to-platelet ratio (NPR) demonstrated the highest diagnostic accuracy (AUC = 0.8254) in differentiating NF from OC.

Conclusions:

Neutrophil-to-lymphocyte ratio (NLR), derived NLR, and neutrophil-to-platelet ratio (NPR) are effective auxiliary biomarkers for distinguishing orbital NF from OC.
The Laboratory Risk Indicator for NF score is not a reliable tool for differentiating these orbital infections.
The accessibility of these biomarkers suggests their potential for integration into routine diagnostic workflows for orbital infections.