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tissue debridement was undertaken at this stage and the patient was transferred to an intensive care setting with intubation, sedation, continued antibiotics and inotropic support. After 72 h, there was no evidence of further progression, and a very clear line of demarcation divided viable and non-viable tissue. The area of necrosis appeared to correspond with the preseptal watershed area between the pretarsal vascular arcades of the upper eyelid and the orbital margin, with sparing of the supraorbital skin above, and the eyelid margin below. Once established, this welldemarcated region of non-viable tissue was excised at the bedside and the wound could heal by secondary intention. The patient made a full recovery without the need for any debilitating surgery. Supported by the series of Luksich et al. [3] this case highlights that radical surgery can in certain circumstances be avoided. We agree with both Luksich and Lim that in necrotising fasciitis, as with any infection, the rich vascular supply to the eyelids and paranasal sinuses mean that appropriate antibiotic therapy can be extremely effective. The key to this approach is early recognition of a necrotising process and prompt identification and management of any sites of high infectious load through radiological investigation and surgical exploration. While this may require drainage of any subcutaneous collection to halt the destructive process as suggested by Luksich, we have successfully extended this therapeutic principle to a case with extensive sinus involvement and septic shock. Of course, it should not be forgotten that the mortality rate associated with periorbital necrotising fasciitis is in the order of 10%, [2] and close observation with a stepwise plan for escalating treatment is advised. However, nor should the morbidity of radical surgery be underestimated [4]. We maintain that the principles proposed by Luksich do present a feasible therapeutic Dear Sir,