title: Periorbital necrotising fasciitis.
abstract: Necrotising fasciitis involving the periorbita is a devastating infection. Potential outcomes range from severe disfigurement, loss of the eye and even to death. Early recognition is critical, although its initially non-distinctive appearance frequently delays diagnosis and treatment. Herein, the authors have performed a systematic review of previously published cases including clinical features, diagnoses and differential diagnoses, pathological characteristics and management. Periorbital necrotising fasciitis is seen mainly in adults with a female predominance (54%); about one-half (47%) of the patients were previously healthy. The infection can follow local blunt trauma (17%), penetrating injuries (22%) and face surgery (11%), but in about one-third of cases (28%) no cause was identified. Non-specific erythema and localised painful swelling of the eyelids characterise the earliest manifestation of the disease, followed by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection was mainly β-haemolytic Streptococcus alone (50%), occasionally in combination with Staphylococcus aureus (18%). The overall mortality rate was 14.42%. The main risk factor for mortality was the type of causative organism, since all reported cases of death were caused by β-haemolytic Streptococcus alone or associated with other organisms. Unlike necrotising fasciitis affecting other body sites, there was not a strong correlation with age >50 years or the presence of associated chronic illness. Management of periorbital necrotising fasciitis is then based on early distinction of symptoms and signs and aggressive multidisciplinary treatment. Thus, the delay between initial debridement and initiating parenteral broad-spectrum antibiotic therapy should be considered the most critical factor influencing morbidity and mortality.
authors.affiliation: Plastic and Reconstructive Surgery Surgery Unit, Hospital of Pisa, Italy. davidelazzeri@gmail.com
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Stefano
authors.initials: S
authors.lastname: Lazzeri
authors.forename: Michele
authors.initials: M
authors.lastname: Figus
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.forename: Guido
authors.initials: G
authors.lastname: Bocci
authors.forename: Livio
authors.initials: L
authors.lastname: Colizzi
authors.forename: Giordano
authors.initials: G
authors.lastname: Giannotti
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lorenzetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Gandini
authors.forename: Romano
authors.initials: R
authors.lastname: Danesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
authors.forename: Mario
authors.initials: M
authors.lastname: Del Tacca
authors.forename: Marco
authors.initials: M
authors.lastname: Nardi
authors.forename: Marcello
authors.initials: M
authors.lastname: Pantaloni
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents