[Necrotizing fasciitis of the eyelids and orbit: a life-threatening ophthalmological emergency].
BACKGROUND
Necrotizing fasciitis is an extremely serious exceptional infectious process affecting subcutaneous soft tissues with skin gangrene and vascular thromboses. Starting from a case repat of necrotizing fasciitis of the eyelids and orbit, which occurred in a child of 4, we analyse the early diagnostic elements and the urgency of treatment of a pathology which can rapidly be life-threatening.


METHODS
A child, aged 4 presented a necrotizing fasciitis of the eyelid and orbit with serious toxic shock, after minor skin abrasion.


RESULTS
Resuscitation and parenteral antibiotic therapy were not sufficient to stop the necrotizing process, which required surgical debridement of gangrenous tissues.


CONCLUSIONS
Necrotizing fasciitis is a rare affection with fatal local and general prognosis. Location on the orbit and eyelids is extremely rare, with only a score of cases recorded in the literature, principally in adults. Our observation shows the possibility of occurrence in a young child and found the typical features of the pathology: minor initial trauma, beta hemolytic streptococcus, extremely fast progression requiring resuscitation, extensive antibiotic therapy and surgical excision of the gangrenous tissues. Eyesight remained intact, but cases of blindness have been described in the literature. Secondary reconstructive surgery on the eyelids may be necessary.


CONCLUSIONS
Urgent diagnosis of this exceptional pathology that may affect the young child and prompt antibiotic therapy and surgical debridement are the only guarantees of survival of infected patients.
Costet-Fighiera
C
C
Ophtalmologie pédiatrique, CHU Nice, Hôpital Archet 2, 151 Route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice Cedex 3, France.
Lagier
J
J
Bastiani-Griffet
F
F
Bernard
E
E
Gastaud
P
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004630:Emergencies; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D009916:Orbital Diseases / Q000175:diagnosis* / Q000188:drug therapy; D012151:Resuscitation; D012772:Shock, Septic / Q000150:complications
D000900:Anti-Bacterial Agents