A 80-year-old female of moderate build who presented with complaints of pain, redness and severe swelling of the lids of left eye since 3 days following an insect bite. On examination she had severe edema of left eyelids extending to upper cheek area, blackish discoloration of lower periorbital skin. Slit lamp biomicroscopy did not reveal any abnormality in either of eyes. Microbiological investigations both examination of Gram stained smear and cultures did not show any microorganism. The patient was initially started on broad-spectrum intravenous antibiotics but did not show favourable response. Therefore, surgical debridement in two sittings followed by reconstruction with cheek rotation flap was performed. Patient responded favourably to surgical treatment. This case demonstrates that ophthalmologists should have high index of suspicion as necrotising fasciitis may occur following insect bite even in immuno-competent patients. Emergent surgical management coupled with parenteral broad spectrum antibiotics may limit ocular morbidity.
Sharma R, Sujatha R, Mahesh A, Sharma A, Nagaraja KS
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