{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:03:23Z","timestamp":1771927403963,"version":"3.50.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:p>\n                    Necrotizing fasciitis is a rapidly progressive infection commonly associated with group A\n                    <jats:italic>Streptococci<\/jats:italic>\n                    and other toxin-producing bacteria that leads to microvascular thrombosis, tissue ischemia, and fascial plane spread. Although the periorbital region\u2019s rich vascularity and natural anatomic barriers help limit deep extension and systemic spread, periorbital necrotizing fasciitis (PNF) can cause septicemia, systemic toxicity, and death. Early diagnosis is critical but remains challenging; distinguishing PNF from inflammatory mimics such as Sweet\u2019s syndrome is critical given their opposing interventions. Surgical debridement along with intravenous antibiotics remain the cornerstone of treatment. However, considering the significant morbidity from vision loss and disfigurement, the decision to pursue early surgical debridement versus conservative management remains an area of active debate. Emerging blood biomarkers may aid diagnosis, and adjunctive therapies, including hypochlorous irrigation, show promise in improving outcomes of PNF while minimizing treatment-associated morbidities. This mini-review synthesizes current treatment evidence for PNF, integrating findings from PNF-focused literature and studies of generalized-NF at other anatomical sites. While principles utilized in the treatment of generalized NF may be applicable to PNF, exact statistics may vary by anatomic site.\n                  <\/jats:p>","DOI":"10.3389\/fopht.2026.1758717","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T05:41:09Z","timestamp":1769406069000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Periocular necrotizing fasciitis"],"prefix":"10.3389","volume":"6","author":[{"given":"Zaynab","family":"Somani","sequence":"first","affiliation":[{"name":"University of Minnesota Medical School","place":["Minneapolis, MN, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun Jun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Neurosciences, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Neurosciences, University of Minnesota","place":["Minneapolis, MN, United States"]},{"name":"Department of Otolaryngology and Head and Neck Surgery, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Mokhtarzadeh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Neurosciences, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199708000-00013","article-title":"Necrotizing fasciitis of the face","volume":"107","author":"Shindo","year":"1997","journal-title":"Laryngoscope"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s0161-6420(91)32334-0","article-title":"Eyelid necrosis and periorbital necrotizing fasciitis. Report of a case and review of the literature","volume":"98","author":"Kronish","year":"1991","journal-title":"Ophthalmology"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3201\/eid0908.020745","article-title":"Invasive group A streptococcal disease: risk factors for adults","volume":"9","author":"Factor","year":"2003","journal-title":"Emerg Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/1749-7922-6-46","article-title":"Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs","volume":"6","author":"Roje","year":"2011","journal-title":"World J Emerg Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.06.037","article-title":"Periocular necrotizing fasciitis with visual loss pathogenesis and treatment","volume":"113","author":"Elner","year":"2006","journal-title":"Ophthalmology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1111\/j.1755-3768.2012.02420.x","article-title":"Periorbital necrotizing fasciitis \u2013 a review","volume":"91","author":"Amrith","year":"2013","journal-title":"Acta Ophthalmol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2009.167486","article-title":"Periorbital necrotising fasciitis","volume":"94","author":"Lazzeri","year":"2010","journal-title":"Br J Ophthalmol"},{"key":"B8","article-title":"Lateral cantholysis and eyelid necrosis secondary to Pseudomonas aeruginosa","volume":"20","author":"Prendiville","year":"1988","journal-title":"Ann Ophthalmol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3109\/01676830903258847","article-title":"Bilateral necrotising fasciitis of the ocular adnexa secondary to Pseudomonas aeruginosa septicaemia in a HIV-positive child","volume":"29","author":"Scheepers","year":"2010","journal-title":"Orbit"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1080\/09273948.2022.2032190","article-title":"Pathophysiological considerations in periorbital necrotizing fasciitis: A case report","volume":"31","author":"Hadizamani","year":"2023","journal-title":"Ocul Immunol Inflamm"},{"key":"B11","article-title":"Flow-through instillation of hypochlorous acid in the treatment of necrotizing fasciitis","volume":"28","author":"Crew","year":"2016","journal-title":"Wounds"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1177\/1721727X221141822","article-title":"Clinical analysis of diagnosis and treatment of necrotizing fasciitis","volume":"10","author":"Yu","year":"2022","journal-title":"Eur J Inflammation"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-024-04908-6","article-title":"Periorbital necrotizing fasciitis: clinical perspectives on nine cases","volume":"43","author":"Oliver-Gutierrez","year":"2024","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.mporth.2016.05.001","article-title":"Necrotizing soft tissue infection: principles of diagnosis and management","volume":"30","author":"Harrison","year":"2016","journal-title":"Orthop Trauma"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-013-1813-2","article-title":"Necrotizing fasciitis: an urgent diagnosis","volume":"43","author":"Paz Maya","year":"2014","journal-title":"Skeletal Radiol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-007-0358-5","article-title":"Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention","volume":"26","author":"Kuo","year":"2007","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12071464","article-title":"Clostridial myonecrosis: A comprehensive review of toxin pathophysiology and management strategies","volume":"12","author":"Hussain","year":"2024","journal-title":"Microorganisms"},{"key":"B18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1080\/01676830601174692","article-title":"Non-progressive periorbital necrotising fasciitis","volume":"27","author":"Hu","year":"2008","journal-title":"Orbit"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318232a6b3","article-title":"Necrotizing fasciitis: classification, diagnosis, and management","volume":"72","author":"Lancerotto","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000004895","article-title":"Periorbital necrotizing fasciitis in a child without a predisposing factor","volume":"44","author":"I\u015fik","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1097\/01.ccm.0000129486.35458.7d","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"Wong","year":"2004","journal-title":"Crit Care Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.203.3.9169717","article-title":"Necrotizing fasciitis: CT characteristics","volume":"203","author":"Wysoki","year":"1997","journal-title":"Radiology"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/112067211002000129","article-title":"Periorbital necrotizing fasciitis: outcomes using a CT-guided surgical debridement approach","volume":"20","author":"Saldana","year":"2010","journal-title":"Eur J Ophthalmol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000002864","article-title":"Derived neutrophil-to-lymphocyte and neutrophil-to-platelet ratios distinguish sinusitis-related orbital cellulitis from periorbital necrotizing fasciitis","volume":"41","author":"Wladis","year":"2025","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000002463","article-title":"Periorbital necrotizing sweet's syndrome: A case report","volume":"39","author":"Watson","year":"2023","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2012.285","article-title":"'Stalled' periocular necrotising fasciitis: early effective treatment or host genetic determinants","volume":"27","author":"Mutamba","year":"2013","journal-title":"Eye (Lond)"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2015-307445","article-title":"Periocular necrotising fasciitis: a multicentre case series","volume":"100","author":"Rajak","year":"2016","journal-title":"Br J Ophthalmol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijregi.2024.100413","article-title":"Necrotizing fasciitis of the head and neck in era of COVID-19: a single-institution experience","volume":"12","author":"Zadjali","year":"2024","journal-title":"IJID Reg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1080\/23320885.2022.2028550","article-title":"Upper extremity necrotizing fasciitis in a Covid-19 patient","volume":"9","author":"Sankaranarayanan","year":"2022","journal-title":"Case Rep Plast Surg Handb Surg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.4103\/sjopt.sjopt_87_25","article-title":"Necrotizing orbital infections: A comprehensive review","volume":"39","author":"Pakdel","year":"2025","journal-title":"Saudi J Ophthalmol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1186\/s12886-025-04062-3","article-title":"Periorbital necrotizing fasciitis: the Manchester experience","volume":"25","author":"Hopkins","year":"2025","journal-title":"BMC Ophthalmol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2011.241","article-title":"Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients","volume":"26","author":"Tambe","year":"2012","journal-title":"Eye (Lond)"},{"key":"B33","first-page":"S2","article-title":"Expert recommendations for the use of hypochlorous solution: science and clinical application","volume":"61","author":"Armstrong","year":"2015","journal-title":"Ostomy Wound Manage"},{"key":"B34","article-title":"Fungal necrotizing fasciitis of the head and neck in 3 patients with uncontrolled diabetes","volume":"93","author":"Prasanna Kumar","year":"2014","journal-title":"Ear Nose Throat J"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajoc.2024.102033","article-title":"Periorbital necrotizing sweet syndrome: A report of two cases mimicking necrotizing soft tissue infections","volume":"34","author":"Vongsachang","year":"2024","journal-title":"Am J Ophthalmol Case Rep"}],"container-title":["Frontiers in Ophthalmology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fopht.2026.1758717\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:11:10Z","timestamp":1771924270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fopht.2026.1758717\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":35,"alternative-id":["10.3389\/fopht.2026.1758717"],"URL":"https:\/\/doi.org\/10.3389\/fopht.2026.1758717","relation":{},"ISSN":["2674-0826"],"issn-type":[{"value":"2674-0826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]},"article-number":"1758717"}}