Surviving the Uncommon: A Case of Unilateral Periorbital Necrotising Fasciitis

Periorbital necrotising fasciitis (PNF) is a devastating and rare infection of the subcutaneous soft tissues with necrosis of the superficial fascia. PNF can cause vision loss, disfigurement and, if left untreated, can lead to multi-organ failure, shock, and eventually death. There is no definite protocol to manage PNF, but it is universally accepted that the treatment should consist of broad-spectrum antibiotics and surgical debridement of the affected tissue. The authors present the case of a 68-year-old man who arrived at the emergency department with severe pain, swelling, and eschar in the left eye. He also reported neck and lower-jaw pain with restricted movement, difficulty swallowing, and complete loss of vision in the left eye. These symptoms developed 2 days after he sustained a facial injury from a fall on his bathroom floor. Necrotising fasciitis started to develop after a few days, and he was diagnosed with streptococcal PNF. The patient thus required multiple surgical debridements, along with a course of broad-spectrum antibiotics. This case highlights the importance of early detection of PNF. Rapid detection and a coordinated multidisciplinary approach can be crucial in saving patients’ lives. Patients with redness, swelling, and pain in the periorbital area that developed after a trauma, even if minor, must seek medical attention to avoid serious complications.