We report the case of a 46-year-old man with a rapidly progressive post-traumatic periocular infection after falling into a puddle of water, with right temporoparietal wounds. He developed bilateral eyelid edema, periocular skin necrosis, crepitus, and inflammatory extension to the malar, temporal, and parietal regions, requiring admission to the intensive care unit, broad-spectrum intravenous antibiotic therapy, and multiple interventions for debridement and drainage of collections. Initial computed tomography showed extensive preseptal cellulitis without postseptal involvement. Methicillin-sensitive Staphylococcus aureus and Lodderomyces elongisporus were isolated from biopsy specimens of devitalized eyelid tissue on bacterial and fungal cultures, respectively. The clinical course was favorable after medical and surgical treatment, with discharge after 20 days, final visual acuity of 20/20 in both eyes, and no ophthalmic sequelae. This case highlights the importance of comprehensive microbiological investigation and a multidisciplinary approach in post-traumatic periocular infections with an atypical course.
