title: Periocular necrotising fasciitis: a multicentre case series.
abstract: BACKGROUND
  Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone.
  
  
  RESULTS
  Twenty-nine patients (20 men; 69%) with PONF were identified and followed up for between 2 months and 10 years (median 57, mean 52.6 months) between 1990 and 2013. Conditions associated with chronic immunocompromise were present in 16/29 (55%). Twenty-one (75%) recalled minor periocular trauma or an infected lesion, two having been assaulted by the same assailant. Systemic shock occurred in 6/29 (21%) patients and 1 died. Group A, β-haemolyticStreptococcuswas the most common bacterium identified (25/29, 86%). Intravenous antibiotics were used in all patients, and up to five tissue debridements were required to control the disease in 23/29 (74%); reconstructive surgery was required in 12/29 (41%) patients. One patient died from the disease and visual loss occurred in four eyes of four patients (14%).
  
  
  CONCLUSIONS
  PONF has a better prognosis than disease elsewhere in the body, but is still associated with significant risk of visual loss and a small risk of death. Intravenous antibiotic treatment with cautious observation may be reasonable in selected patients with a low threshold for debridement.
authors.affiliation: Adnexal, Moorfields Eye Hospital, London, UK.|International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.|South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Saul N
authors.initials: SN
authors.lastname: Rajak
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Edwin C
authors.initials: EC
authors.lastname: Figueira
authors.affiliation: Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Anjana S
authors.initials: AS
authors.lastname: Haridas
authors.affiliation: Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
authors.forename: Khami
authors.initials: K
authors.lastname: Satchi
authors.affiliation: Adnexal, Moorfields Eye Hospital, London, UK.
authors.forename: Jimmy M
authors.initials: JM
authors.lastname: Uddin
authors.affiliation: Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
authors.forename: Alan A
authors.initials: AA
authors.lastname: McNab
authors.affiliation: Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Rene
authors.affiliation: Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Sullivan
authors.affiliation: Adnexal, Moorfields Eye Hospital, London, UK.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Rose
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Eye Lids; Infection