Case Report/Case Series |

Periocular Necrotizing Fasciitis Causing Blindness

David R. Shield, MD1; Javier Servat, MD1; Sean Paul, MD2; Roger E. Turbin, MD3; Annie Moreau, MD2; Adam de la Garza, MD4; Edward El Rassi, MD2; Jonathan Silbert, MD1; Robert Lesser, MD1; Flora Levin, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
2Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma
3University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey
4Baker, Holloman & Ehrlich, Oklahoma City, Oklahoma
JAMA Ophthalmol. 2013;131(9):1225-1227. doi:10.1001/jamaophthalmol.2013.4816.
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Importance  Periocular necrotizing fasciitis is a rare but potentially devastating disease, accompanied by high rates of morbidity and mortality.

Observations  We report 5 cases of periocular necrotizing fasciitis resulting in severe vision loss, 3 of which required exenteration to contain the disease and only 1 of which recovered vision. Three cases were caused by group A streptococcus; 1, by methicillin-resistant Staphylococcus aureus; and 1, by Streptococcus anginosus constellatus.

Conclusions and Relevance  Providers should maintain a high clinical suspicion for necrotizing fasciitis and distinguish it from more common forms of cellulitis. As seen in these 5 cases, periocular necrotizing fasciitis may cause severe visual loss more often than previously recognized. To our knowledge, this is also the first report of Streptococcus anginosus constellatus causing necrotizing fasciitis.

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Figure 1.
Case 1

A, On presentation. B, Immediately after reconstruction. C, After subsequent debulking of thigh skin graft.

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Figure 2.
Case 2

A, On presentation. B, Immediately after reconstruction. C, With prosthesis in place.

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Figure 3.
Case 5

A, On presentation. B, After debridement.

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Periorbital necrotizing fasciitis -- a review. Acta Ophthalmol 2013;91(7):596-603.
Periocular necrotizing fasciitis causing blindness. JAMA Ophthalmol 2013;131(9):1225-7.