Purpose

Dermis-fat (DF) grafts are used in reconstruction of the anophthalmic socket, both primarily after enucleation and secondarily after extrusion or migration of an existing implant, contracted socket, large orbital defects, traumatic destruction, certain pediatric cases. This clinical case presents DF reconstruction of large orbital defect after nearly 50 repeated parabulbar injections (PI). Abscess drainage was performed, followed by tissue necrosis, necrotizing fasciitis (NF) was suspected. NF is a rapidly progressive, life-threatening soft tissue infection and represents both a medical and surgical emergency.

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Methods

Case Presentation
A 41-year-old male presented in April 2025 with complaints of a non-healing wound of the left eye, purulent discharge from the wound, and no pain. The patient’s history was left eye uveitis, ocular toxoplasmosis one month earlier, and nearly 50 PI within one month abroad. He took intravenous cephalosporins previously, and orbital abscess drainage had been performed. During the initial examination, the inferior orbital tissues were exposed, and the sclera was visible within the wound. The eyeball was in the correct position, and ocular motility was intact. CT imaging demonstrated fascial thickening without gas formation or bone erosion. After two days, the patient developed chemosis, conjunctivitis, and signs of scleral melting. NF was suspected, although inflammatory markers and laboratory findings were within normal limits. Surgery was performed: removal of all necrotic tissue and drainage. DF transplantation was performed one month later.

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Results

The orbital defect was successfully reconstructed. Eyelid position and condition were satisfactory, and the patient reported no additional ocular complaints.

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Conclusion

DF grafting is an excellent option for orbital reconstruction; however, it remains challenging for both surgeons and patients. The aim of this clinical case report is to demonstrate the beneficial outcomes of DF and to emphasize the potential risks associated with repeated PI.

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Additional Authors

First name	Last name	Base Hospital / Institution
ARMINE	GHARAKESHISHYAN	Ophthalmological center after S.V.Malayan / Yerevan State Medical University

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