Periocular necrotizing fasciitis: a review of five cases.
OBJECTIVE
The purpose of the study is to display a spectrum of clinical presentations of periocular necrotizing fasciitis caused by group A streptococci and to discuss recent trends and treatment of this disease.


METHODS
A case series of five patients (four female and one male) was seen between July 1990 and January 1995 in four university centers. All had clinical evidence of periocular necrotizing fasciitis and grew group A streptococci on wound cultures or had serologic evidence of streptococcal infection. Details of patient presentation, treatment, and outcome are examined.


RESULTS
The five patients showed a spectrum of clinical severity from a necrotizing infection confined to the eyelid to a potentially fatal, severe shock-like syndrome characterized by sepsis and multiorgan system failure. A history of trauma often was absent. Patients were treated successfully by a combination of appropriate antibiotics and surgical debridement.


CONCLUSIONS
Group A streptococci can cause severe necrotizing infections of the eyelids. Early recognition and prompt treatment can be essential to these patients' survival.
Marshall
D H
DH
Department of Ophthalmology, University of Ottawa Eye Institute, Ontario, Canada.
Jordan
D R
DR
Gilberg
S M
SM
Harvey
J
J
Arthurs
B P
BP
Nerad
J A
JA
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005141:Eyelid Diseases / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D005143:Eyelids / Q000382:microbiology / Q000473:pathology; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology; D012772:Shock, Septic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D013203:Staphylococcal Infections / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification
D000900:Anti-Bacterial Agents