Risk factors:
(1) periorbital trauma, including combat injuries or seemingly minor injuries
(2) periorbital surgery including cosmetic surgery and sinus surgery
(3) self-lancing of a stye (abscess)
(4) substance abuse
(5) diabetes mellitus
(6) immunosuppression or immundoeficiency
In a significant percentage of cases no apparent cause is found.
The patient develops a rapidly progressive cellulitis that may spread to involve subcutaneous tissues and causes necrosis. Clinical features include:
(1) severe pain
(2) fever
(3) diaphoresis and/or rigors
Organisms may include:
(1) group A Streptococcus (Streptococcus pyogenes)
(2) Staphylococcus aureus, including MRSA
(3) anaerobic bacteria
(4) Pseudomonas aeruginosa
(5) fungi
Complications:
(1) loss of eyelid and soft tissue with potential for disfigurement
(2) loss of globe
(3) toxic shock syndrome
(4) cerebral sinus thrombosis
(5) sepsis
Management may involve:
(1) aggressive antibiotic therapy, usually intravenous
(2) surgical debridement, which may need to be guided by imaging studies
(3) hyperbaric oxygen therapy if appropriate.
