Hypochlorous Acid as an Adjunctive Treatment for Periocular Necrotizing Fasciitis

Purpose: To report the outcomes of a small case series of patients with periorbital necrotizing fasciitis (PONF) treated with high-dose intravenous antibiotics and dilute, pure hypochlorous acid (HOCL) irrigated through affected tissues as well as sprayed topically, with no tissue debridement. Methods: In this single-center, retrospective chart review, 6 patients were identified between May 1, 2022, and May 1, 2024, with PONF who had HOCL used during their treatment. The primary outcome measures included successful eradication of infection, acceptable aesthetic result with minimal or no reconstruction required, and little or no loss of vision. Results of treatment were compared with those PONF patients in the literature treated more traditionally with antibiotics and debridement, and those treated with antibiotics alone. Results: Of the 6 patients identified with PONF, all 6 were treated with dilute, pure HOCL (0.033%). The median age of the patients was 51 (range 32–73). The female-to-male ratio was equal. The median follow-up time since the first presentation was 158 days (range 30–180). Streptococcus pyogenes was the most common causative organism, found in 80% of cases. No patient underwent tissue debridement in the periocular area. All patients recovered with minimal sequelae. No patient reported loss of vision on their final follow-up visit. There were no patients who required enucleation or exenteration and no patients died because of PONF. Conclusions: The authors describe a simple method of introducing dilute, pure HOCL (0.033%) without hypochlorite or sodium hypochlorite as impurities via irrigation and topical spray into the treatment plan for PONF. There was little if any loss of tissue with this treatment in this series. The outcomes compared favorably to those outcomes in the literature of PONF patients treated more traditionally with antibiotics and debridement, and those patients treated more conservatively with antibiotics alone. HOCL irrigation and spray techniques appear to be beneficial in the management of PONF and decrease the need to debride, allowing faster disease resolution and contributing to favorable outcomes.