A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valu...
| Authors: | , , , , , , , , , , , |
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| Format: | article |
| Publication Date: | 2025 |
| Country: | España |
| Institution: | Universitat Autònoma de Barcelona |
| Repository: | Dipòsit Digital de Documents de la UAB |
| Language: | English |
| OAI Identifier: | oai:ddd.uab.cat:311315 |
| Online Access: | https://ddd.uab.cat/record/311315 https://dx.doi.org/urn:doi:10.3390/diagnostics15091181 |
| Access Level: | Open access |
| Keyword: | Necrotizing fasciitis Eye infections Soft tissue infections Cellulitis Orbit Necrosis Streptococcus pyogenes |
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A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature Oliver-Gutierrez, David|||0000-0002-0492-8645 Ros-Sanchez, Elena Segura-Duch, Gloria Alonso, Tirso Arcediano, Miguel Ángel|||0000-0001-7234-4919 Herranz Cabarcos, Alejandra|||0000-0002-9407-454X Matas, Jessica|||0000-0003-4448-5575 Castro Seco, Roberto Van der Veen, R. L. P. Boixadera Espax, Anna García Arumí, José|||0000-0001-8827-1160 Oliveres, Joan Necrotizing fasciitis Eye infections Soft tissue infections Cellulitis Orbit Necrosis Streptococcus pyogenes Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis' (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient's eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock. https://ddd.uab.cat/record/311315 https://dx.doi.org/urn:doi:10.3390/diagnostics15091181 |
| title |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature |
| spellingShingle |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature Oliver-Gutierrez, David|||0000-0002-0492-8645 Necrotizing fasciitis Eye infections Soft tissue infections Cellulitis Orbit Necrosis Streptococcus pyogenes |
| title_short |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature |
| title_full |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature |
| title_fullStr |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature |
| title_full_unstemmed |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature |
| title_sort |
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature |
| author |
Oliver-Gutierrez, David|||0000-0002-0492-8645 |
| author_facet |
Oliver-Gutierrez, David|||0000-0002-0492-8645 Ros-Sanchez, Elena Segura-Duch, Gloria Alonso, Tirso Arcediano, Miguel Ángel|||0000-0001-7234-4919 Herranz Cabarcos, Alejandra|||0000-0002-9407-454X Matas, Jessica|||0000-0003-4448-5575 Castro Seco, Roberto Van der Veen, R. L. P. Boixadera Espax, Anna García Arumí, José|||0000-0001-8827-1160 Oliveres, Joan |
| author_role |
author |
| author2 |
Ros-Sanchez, Elena Segura-Duch, Gloria Alonso, Tirso Arcediano, Miguel Ángel|||0000-0001-7234-4919 Herranz Cabarcos, Alejandra|||0000-0002-9407-454X Matas, Jessica|||0000-0003-4448-5575 Castro Seco, Roberto Van der Veen, R. L. P. Boixadera Espax, Anna García Arumí, José|||0000-0001-8827-1160 Oliveres, Joan |
| author2_role |
author author author author author author author author author author author |
| topic |
Necrotizing fasciitis Eye infections Soft tissue infections Cellulitis Orbit Necrosis Streptococcus pyogenes |
| topic_facet |
Necrotizing fasciitis Eye infections Soft tissue infections Cellulitis Orbit Necrosis Streptococcus pyogenes |
| description |
Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis' (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient's eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock. |
| publishDate |
2025 |
| format |
article |
| url |
https://ddd.uab.cat/record/311315 https://dx.doi.org/urn:doi:10.3390/diagnostics15091181 |
| language |
eng |
| eu_rights_str_mv |
openAccess |
| institution |
Universitat Autònoma de Barcelona |
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Dipòsit Digital de Documents de la UAB |
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Dipòsit Digital de Documents de la UAB |
| instname_str |
Universitat Autònoma de Barcelona |
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1878432292114792448 |
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2025 |
| author_browse |
Alonso, Tirso Arcediano, Miguel Ángel|||0000-0001-7234-4919 Boixadera Espax, Anna Castro Seco, Roberto García Arumí, José|||0000-0001-8827-1160 Herranz Cabarcos, Alejandra|||0000-0002-9407-454X Matas, Jessica|||0000-0003-4448-5575 Oliver-Gutierrez, David|||0000-0002-0492-8645 Oliveres, Joan Ros-Sanchez, Elena Segura-Duch, Gloria Van der Veen, R. L. P. |
| score |
6.924472 |