• Manuel Saldana, Deepak Gupta, Mona Khandwala, Robert Weir, and Bijan Beigi.
• Norfolk and Norwich University Hospital, Norwich, UK.
• Eur J Ophthalmol. 2010 Jan 1; 20 (1): 209-14.

PurposeThe surgical management of necrotizing fasciitis usually involves early radical/wide and aggressive debridement of involved areas. We describe 5 cases of periorbital necrotizing fasciitis (NF), managed using a computed tomographic (CT)-guided approach to surgical debridement.MethodsRetrospective case series review.ResultsFive patients (4 female, 1 male; age range 39-81) were treated for periorbital NF. The diagnosis was confirmed in all cases with blood cultures and wound swabs. All patients were managed medically by a surviving sepsis regimen. CT scans confirmed suprafascial infection and excluded orbital cellulitis. Four patients had minimal surgical debridement to the surface muscle. All patients survived. Four out of 5 patients underwent delayed reconstruction.ConclusionsPeriorbital NF behaves differently from NF of other areas. CT-guided surgical debridement of the superficial muscle maximizes preservation of healthy tissue and facilitates reconstruction. Delayed reconstruction allows fibrosis to settle and good cosmetic and functional results are possible. However, NF remains potentially lethal and close observation and a flexible management plan are required.

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