Purpose

Periorbital necrotizing fasciitis (PONF) is a rare, life-threatening infection traditionally managed with aggressive serial debridement. Recent reports describe hypochlorous acid (HOCl) irrigation as a tissue-sparing adjunct. We present a protocol for HOCl irrigation in PONF and report outcomes in four consecutive cases managed with minimal to no debridement.

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Methods

Retrospective review of four consecutive PONF patients treated at a single academic institution. The protocol involves tunneling perforated intravenous tubing through the affected periocular tissue. 10 cc of 0.033% HOCl was irrigated through the tubing every four hours for a minimum of four days. Erythromycin ointment was applied over drain sites, and the wound was covered with HOCl-soaked gauze and Tegaderm. All procedures were performed at bedside.

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Results

Four patients (3 male, 1 female; mean age 42 years) with no significant medical history were treated. Predisposing factors included upper respiratory infection, cat scratch, dog bite, and methamphetamine use. Microbiological evaluation revealed gram-positive cocci, MRSA, group A Streptococcus, and coagulase-negative Staphylococcus. Mean hospitalization was 5.5 days (range 3–9). No patients developed systemic toxicity or required intravenous immunoglobulin, exenteration, or enucleation. One patient required outpatient Integra dermal substitute placement to adress the tissue loss. The remaining three healed without further surgery.

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Conclusion

This protocol modifies previously described approaches by using intravenous tubing instead of Penrose drains and omitting clindamycin-soaked gauze, penicillin solution, and bacitracin ointment. Despite these differences, outcomes were comparable. All patients achieved infection control with globe preservation and minimal debridement. Our cases support the use of this modified protocol for PONF.

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Additional Authors

First name	Last name	Base Hospital / Institution
Angela	Oh	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Tatiana	Rosenblatt	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Frank	Mei	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Katherine	Lucarelli	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Sara	Emami	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Robert A.	Goldberg	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Daniel	Rootman	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA

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