Eyelid and periorbital necrotizing fasciitis, a severe preseptal infection, a systemic review of the literature and anatomical illustrations

In necrotizing fasciitis, aggressive surgical debridement and broad-spectrum antibiotics are the cornerstone of treatment but cannot be proposed for the eyelid and periorbital area because of the risk of blindness, eyeball exposure and disfiguration. The aim of this review was to determine the most effective management of this severe infection while preserving eye function. A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to March 2022; 53 patients were included.

Management was probabilistic, combining antibiotic therapy with skin (+/- orbicularis oculi muscle) debridement in 67.9% of cases, and probabilistic antibiotic therapy alone in 16.9% of cases. Radical surgery with exenteration was performed in 11.1% of patients; 20.9% of patients had complete loss of vision, and 9.4% died of the disease. Aggressive debridement was rarely necessary possibly because of the anatomical particularities of this region.