The Use of Hypochlorous Acid in the Treatment of Periorbital Necrotizing Fasciitis

Periorbital necrotizing fasciitis (PONF) is a severe skin and soft tissue infection that corrupts the body's natural immune response, leading to extensive tissue necrosis that can result in exenteration or death. Reactive oxygen species, such as hypochlorous acid, are among the elements employed by the immune system in fighting bacterial infection. In necrotizing fasciitis this immune response is thwarted, as the responsible pathogens produce enzymes that eliminate these reactive oxygen species. The host immune response can be augmented by the external application of hypochlorous acid to severely infected tissues. This manuscript presents a case series of 18 orbits from 15 patients treated with a novel treatment approach in the orbit-local administration of hypochlorous acid-in addition to traditional treatment with surgical debridement and intravenous antibiotics. Patients in this series were diagnosed with periorbital necrotizing fasciitis and received local hypochlorous acid administration via an orbital catheter and a Penrose drain to allow for flow-through of the bacterial toxins. Hypochlorous acid was well tolerated in all patients. Zero patients underwent exenteration, and zero patients died. Further investigation into hypochlorous acid treatment in periorbital necrotizing fasciitis is warranted.