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Necrotizing orbital infections: A comprehensive review

Summary

Necrotizing orbital infections are serious, fast-spreading infections around the eye caused by bacteria, fungi, or viruses. These infections can cause vision loss and can be life-threatening, especially for people with weakened immune systems. Quick diagnosis and aggressive treatment with antibiotics or antifungal medications, combined with surgery to remove infected tissue, are essential to save sight and prevent death.

Background

Necrotizing orbital infections (NOIs) are rapidly progressive, life-threatening conditions affecting the orbit and periorbital tissues. These infections can be caused by bacterial, fungal, or viral pathogens and are associated with significant morbidity and mortality, particularly in immunocompromised patients. Visual loss occurs in 13.8% of cases with average disease-related mortality of 8%.

Objective

To provide a comprehensive review of necrotizing orbital and periorbital infections including etiopathogenesis, clinical manifestations, diagnostic methods, and evidence-based treatment regimens. The review emphasizes the necessity of a multidisciplinary approach to enhance patient outcomes.

Results

Identified Group A Streptococcus, MRSA, Pseudomonas as primary bacterial pathogens; Mucor, Aspergillus, and Fusarium as major fungal agents; and Herpesviridae family viruses as significant viral etiologies. Management requires prompt broad-spectrum antibiotics, antifungals or antivirals, and surgical debridement. Early diagnosis and intervention significantly reduce morbidity and mortality.

Conclusion

Necrotizing orbital infections require urgent multidisciplinary management combining appropriate antimicrobial therapy with surgical intervention. Early recognition and treatment are critical to prevent serious complications including vision loss, intracranial extension, and death. Prognosis depends on prompt and proper treatment initiation.
  • Published in:Saudi Journal of Ophthalmology,
  • Study Type:Review,
  • Source: PMID: 40642363, DOI: 10.4103/sjopt.sjopt_87_25
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