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Aggressive intervention minimizes sight-threatening potential of periorbital necrotizing fasciitis

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PHILADELPHIA — Early identification, immediate and aggressive surgical intervention, and application of both systemic and postoperative topical clindamycin can be sight-saving in cases of periorbital necrotizing fasciitis, according to a presentation here.

“Necrotizing fasciitis of the periorbital region is an exceedingly rare condition, with less than 100 cases reported over the past 20 years,” Charles Kim, MD, said at the Wills Eye Alumni Conference “To put it in further perspective, the two largest case series to date consist of 17 and seven patients, respectively, so the span of five, our project, would clock in at the third largest.”

Charles Kim

Kim and colleagues conducted a retrospective chart review of seven eyes of five patients with necrotizing fasciitis (NF) at Wills Eye Hospital and Maricopa Medical Center in Phoenix, Ariz. Blood and wound cultures showed Group A β-hemolytic Streptococcus as the causative organism in four of the five patients; the causative organism in the remaining patient was Bacillus. Eyes were involved bilaterally in two of the patients.

“Treatment relies on early surgical debridement,” Kim said.

Patients underwent immediate, aggressive surgical debridement, with application of systemic clindamycin, which inhibits mediators produced by Streptococcus.

“Before, during and after surgery, all our patients are managed with broad-spectrum antibiotics,” Kim said.

Postoperatively, Kim and colleagues’ treatment algorithm involves treatment with topical clindamycin until the edges of the wound begin to granulate, and reconstruction is delayed for a week or two until the infection is cleared,” he said.

“Delayed reconstruction can lead to excellent esthetic outcomes,” he said.

Of the seven eyes in the study, visual acuity was maintained at 20/40 in six eyes. Visual acuity remained at no light perception (NLP) in one case that presented with NLP. – by Kate Sherrer

Reference:

Kim C. Periorbital Necrotizing Fasciitis: The Wills Eye Hospital Experience. Presented at: Wills Eye 68th Alumni Conference; March 10-12, 2016; Philadelphia, Penn.

Disclosure: Kim reports no relevant financial disclosures.