Author(s):
1. Tanja Petrovic, Republic of Srpska, Bosnia and Herzegovina

Abstract:
Necrotizing fasciitis is an extremely rare, rapidly progressive necrosis which first attacks a subcutaneous soft tissue, and later the skin.Unless the treatment is not undertaken early and adequately, it could be even lethal.The basis for its treatment is surgical removal of the necrotic tissue in combination with an intensive antibiotic treatment. Our goal is to present a case of necrotizing fasciitis of the upper eyelid,which, despite the developed system complications,ended up in the recovery. In October of 2010,a previously healthy 60-year-old woman,was sent to the ophthalmology department of General Hospital Doboj because of swelling and redness of the upper eyelid of the left eye.After a detailed case history and clinical examination,necrotizing fasciitis was suspected and the patient was hospitalized.After detailed history and clinical examination set is suspected necrotizing fasciitis, and hospitalized patients.The laboratory analysis were done,a dermatologist was consulted, and the incision was done,after which changes were obtained by manual expression of blood content.High doses of wide-spectrum antibiotic were prescribed.Due to a poor general condition, fever,tachycardia,decreased diuresis and lowering of blood pressure,the patiend was moved to the Department of Internal Medicine under the constant supervision of an ophthalmologists.After 11 days of hospitalization,with good general condition and the changes of the eyelid,the patient was released from the hospital and sent home,with local and systemic antibiotic therapy. Necrotizing fasciitis is a rare and potentially lethal condition.According to the literature,the incidence of the disease is 0.4 to 5,8 on 100 000 people per year.It most often occurs at the place of a previous injury,in all age groups and is equally present in both sexes.Early diagnosis is usually missed,due to deficient clinical symptoms and partly due to insufficient clinical experience.An initial treatment includes intravenous use of antibiotics,but in spite of the adequate treatment,the large number of cases has a lethal outcome.An early diagnosis and a proper treatment are the most important factors for improvement of outcome of the necrotizing fasciitis. The aim of this study was to highlight the importance of a fast diagnosis and early initiation of therapy.Also, one of the goals of this work is to ask a question whether we have prevented further necrosis with incision,which is not mentioned in the literature?According to the literature,the surgical treatment consists of wide surgical excision of emergency necrotic tissue, which we tried to avoid, particularly due to the localization of the changes of highly visible part of the face. Our case suggests that timely diagnosis,adequate antibiotic therapy, without surgical excision can be complete recovery.

Key words:
incision, necrotizing fasciitis

Opening paper:
Yes

Date of abstract submission:
29.03.2012.

Number of visits:
814

Conference:
II Kongres oftalmologa BiH