Predictors of disease severity and outcomes in periorbital necrotising fasciitis

Background/aims To identify predictors of disease severity in periorbital necrotising fasciitis (PNF) and evaluate outcomes according to surgical approach. Methods All patients treated for PNF at a tertiary eye department between 2014 and 2024 were included. Demographic and clinical data were collected, including symptom onset, visual acuity and tissue involvement. Tissue involvement was quantified using a score assigning one point for each affected area (upper eyelid, lower eyelid, forehead, cheek and neck). The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was calculated from admission laboratory values. Patient variables were correlated with length of hospitalisation (intensive care unit (ICU) days <10 vs ≥10). Treatment strategies were analysed according to surgical approach—radical (radical debridement (RD)) versus tissue-sparing debridement (non-RD). Post-treatment complications, including eyelid disfigurement and need for reconstructive surgery, were assessed. Results 12 patients were included (median age: 71 years, range: 5–86). One died from multiorgan failure. An ICU stay exceeding 10 days was significantly associated with older age (55 (5–72) years, vs 81 (71–86), p=0.004) and higher LRINEC scores (4.5 (1–8) vs 10 (3–10), p=0.04). RD patients had significantly greater tissue involvement (2 (1–3) (non-RD) vs 3.5 (3–5) (RD), p=0.02). RD was associated with longer ICU stays (2.5 (0–10) vs 23 (4–77) days, p=0.04) and showed a trend toward more long-term complications (14% (non-RD) vs 100% (RD), p=0.08). Conclusion LRINEC score and age were predictors of PNF severity and prolonged ICU care. Non-RD did not demonstrate inferior outcomes compared with RD.