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Case Report/Case Series
September 2013

Periocular Necrotizing Fasciitis Causing Blindness

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

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.