Successful management of bilateral periorbital necrotising fasciitis with ocular involvement

A 4-year-old girl had suffered from multiple pustules and severely swollen eyelids for a week which led to difficulties in opening her eyes. The pustules burst 2 days prior to admission, causing blood and pus to come out. As a result, the evaluation of eye movement, visual acuity and intraocular pressure was hindered. Eyelids were spasming, hyperaemic, warm and of soft consistency on palpation. Crust and necrotic tissues were also observed. The patient had a history of fever with cough and nasal congestion. CT scan revealed soft tissue thickening on bilateral anterolateral periorbital region. She also underwent debridement in both eyelids, followed by partial periosteal graft on the left eye due to corneal perforation. During follow-up after 1.5 months, she also underwent excision of the periosteal graft and synechiolysis, followed by cataract extraction of the left eye.