Periorbital Necrotizing Fasciitis: Presentation to management

Periorbital necrotizing fasciitis is a rare but severe infection that spreads quickly along the fascial planes, often leading to sepsis and is associated with considerable morbidity and high mortality rate. Early recognition is paramount, yet initial symptoms such as localized pain and eyelid swelling are often nonspecific. These are quickly followed by blister formation, periorbital skin and subcutaneous tissue necrosis, and systemic symptoms. Management of necrotizing fasciitis usually involves aggressive surgical debridement alongside broad-spectrum intravenous antibiotics. However, this approach is unsuitable for the periorbital area owing to the risks of eyeball exposure, decline in vision, and disfigurement. In this report, we present the case of an 85-year-old male patient who was referred to our clinic for evaluation of a suspected upper eyelid abscess, accompanied by a rapidly worsening decline in his overall clinical condition. The patient underwent 2 surgical debridements of the periorbital area, followed by reconstruction using a combination of a Mustardé cheek advancement flap and full-thickness skin graft. No surgical complications were observed, and the patient achieved aesthetic and functional improvement shortly after definitive reconstruction. Early recognition and debridement are crucial to ensure satisfactory outcomes, while reconstructive surgery techniques allow satisfactory cosmetic results.