Necrotising fasciitis of the eyelid with toxic shock due to Pseudomonas aeruginosa

Lim VSY, Amrith S
Correspondence: Dr Shantha Amrith, ophv14@nus.edu.sg

ABSTRACT
Necrotising fasciitis is a rare and rapidly spreading soft tissue infection characterised by widespread necrosis of the superficial fascia and usually occurring in the limbs and the abdominal wall. Periocular necrotising fasciitis is unusual due to the excellent blood supply of the facial region. The usual pathogens are Group A beta-haemolytic Streptococcus and Staphylococcus aureus. We report a case of Pseudomonas necrotising fasciitis of the eyelid with septic shock, initially diagnosed as hordeolum in a young immunocompromised Chinese woman. Early recognition of the condition, followed by timely intervention with surgical debridement and intensive intravenous antibiotic treatment led to a favourable prognosis. It is important for general physicians to recognise the cardinal signs of necrotising fasciitis, as early treatment with timely surgical debridement and supportive medical therapy is the mainstay to successful management.

Keywords: necrotising fasciitis, periocular infection, Pseudomonas aeruginosa, septic shock
Singapore Med J 2010; 51(3): e51-e53