Periocular necrotizing fasciitis with visual loss pathogenesis and treatment.
OBJECTIVE
To illustrate the role of clinically necessary aggressive subcutaneous debridement with limited excision of necrotic skin in treating necrotizing faciitis, while demonstrating the histopathologic basis of orbital spread and blindness complicating this disorder.


METHODS
Observational retrospective case series.


METHODS
Seven consecutive patients cared for by the Eye Plastic and Orbital Surgery Services at the University of Michigan and University of Iowa.


METHODS
Retrospective review of ocular findings, systemic features, management, outcome, and histopathology of debrided tissue from 7 patients with periocular necrotizing fasciitis.


METHODS
Patient survival and morbidity.


RESULTS
Bilateral involvement was present in 6 of the 7 patients. Five patients suffered ophthalmic or central retinal artery occlusion with loss of vision. All patients underwent extensive debridement of subcutaneous tissue with sparing of overlying nonnecrotic skin and intensive systemic antibiotic therapy. Four patients required unilateral exenteration. After a mean follow-up of 38 months, 6 patients were alive; 1 died perioperatively due to septic shock. Histopathology, not previously described, showed inflammation to spread preferentially along eyelid fibrofatty-fascial tissue planes into the orbit and along orbital fibrous septae, leading to intense perivascular inflammation, thrombosis, and ocular infarction.


CONCLUSIONS
Necrotizing fasciitis is a potentially fatal disease that often causes blindness when affecting the periocular region. To reduce morbidity and mortality in severe infections, prompt subcutaneous debridement and limited resection of necrotic skin are usually necessary.
Elner
Victor M
VM
Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan 48105, USA.
Demirci
Hakan
H
Nerad
Jeffrey A
JA
Hassan
Adam S
AS
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001766:Blindness / Q000209:etiology*; D003131:Combined Modality Therapy; D003646:Debridement; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000473:pathology / Q000628:therapy; D005141:Eyelid Diseases / Q000150:complications* / Q000473:pathology / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000473:pathology / Q000628:therapy; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000473:pathology; D009916:Orbital Diseases / Q000150:complications* / Q000473:pathology / Q000628:therapy; D015356:Retinal Artery Occlusion / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity
D000900:Anti-Bacterial Agents