Orbital Necrotizing Fasciitis: A Comprehensive Review of Diagnosis and Management

Abstract Purpose of Review This review aims to synthesize current knowledge on orbital necrotizing fasciitis (ONF), a rare but rapidly progressive and potentially fatal infectious condition. It is caused by various species of flesh-eating pathogens that can be challenging to eradicate due to their rampant infiltration across the orbital septum. The goal is to highlight diagnostic challenges, outline evidence-based management strategies, and evaluate emerging adjunctive therapies. Recent Findings Recent literature underscores the diagnostic difficulty of ONF due to its initial resemblance to benign periocular infections. Elevated inflammatory markers and cross-sectional imaging are critical to early identification. Prompt surgical debridement and intravenous broad-spectrum antibiotics remain standard care. Adjunctive modalities—including systemic corticosteroids, intravenous immunoglobulin (IVIG), negative pressure wound therapy, and hyperbaric oxygen—have been explored, with early reports also supporting the use of hypochlorous acid–based wound management. Summary Early recognition and multidisciplinary management are essential to reducing morbidity and mortality in ONF. While surgery and antibiotics are the cornerstone of treatment, adjunctive therapies show promise and warrant further investigation. Future research should focus on standardized protocols and clinical trials to validate these emerging interventions.