A German tertiary eye department reviewed 12 patients treated for periorbital necrotising fasciitis over ten years; one died of multiorgan failure.
Older patients and those with higher admission LRINEC scores were more likely to spend ten days or more in intensive care. Patients with more extensive tissue involvement had radical debridement, and that group had longer ICU stays and a trend towards more long-term complications such as eyelid disfigurement. Tissue-sparing debridement did not appear to produce worse outcomes.
With 12 patients, these are observations, not proof. The comparison between surgical approaches is confounded by severity: the sickest patients had the most radical operations. The practical value is in recognising that a high LRINEC score in an older patient predicts a long, intensive course, and in supporting a tissue-sparing approach where disease extent allows.
- Calculate the LRINEC score on admission for suspected periorbital necrotising fasciitis.
- Expect a prolonged intensive care course in older patients with high LRINEC scores, and involve ICU early.
- Start broad-spectrum antibiotics and arrange urgent surgical assessment without waiting for imaging if clinical suspicion is high.
- Consider tissue-sparing debridement where disease extent allows, given the eyelid's functional importance.
Why it matters
Periorbital necrotising fasciitis is rare enough that most clinicians meet it unprepared.
Don't overread it
Twelve patients and confounding by severity mean the surgical comparison cannot guide technique on its own.
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