Severe Periocular Inflammatory Reaction Mimicking Necrotizing Fasciitis following Hyaluronic Acid Microinjections: A Case Report and Literature Review

Introduction: Hyaluronic acid (HA) fillers are widely utilized in esthetic medicine for facial rejuvenation, including in the periocular region. Although generally considered safe, severe inflammatory responses can occur. This report describes a case of a 42-year-old woman who developed a significant periocular reaction following HA microinjections, clinically resembling necrotizing fasciitis. Case Presentation: The patient, with no significant medical or ophthalmic history, presented to the emergency department with acute periocular swelling, redness, and an inability to open her right eye 3 h after HA microinjections. Clinical examination revealed marked periorbital edema, chemosis, and restricted ocular motility in the right eye. The severity of the presentation initially suggested necrotizing fasciitis. A CT scan indicated preseptal cellulitis without post-septal involvement. Treatment with intravenous antibiotics, systemic corticosteroids, antihistamines, and topical therapies led to significant improvement. Conclusion: This case highlights the need to recognize severe inflammatory reactions following periocular HA injections, which may mimic life-threatening conditions. Timely intervention and systematic evaluation are essential for achieving favorable outcomes.