Streptococcal Necrotizing Fasciitis Complicating a Conjunctival Dacryocystorhinostomy

Periorbital necrotising fasciitis

“…Although there are known risk factors (table 2), mainly related to mild (alcoholism,6 17 20 23 26 29 32 35 36 44 45 52 53 55 64 70 diabetes,6 10 11 15 22 50 51 58 68 rheumatological disease,18 45 48 chronic corticosteroid use and a combination of these conditions25 40 55) and severe (chemotherapy for malignancies and lymphoproliferative disorders)28 41 48 62 67 immune suppression, about one-half of the patients with reported NF were previously healthy 4 6–8 12 13 16 19 21 23 24 27 30–35 37–39 41–43 45–47 49 54–57 60 63 66 69 72–74. Haematological malignancy itself (our case) and neutropenia caused by chemotherapy may be an important predisposing factor for NF, because of the reduction in the number and activity of effector cells such as neutrophils and monocytes, and disruption of the barrier function of mucosal membranes.…”

“…The infection may follow (table 2) local blunt trauma,6 14 15 17 21 27 29 30 33 34 42 49 53 55 57 73 or any condition in which the integrity of eyelid integument is compromised by abrasion, laceration or penetrating injuries 4 6–8 11 20 23–26 31 32 35–37 45 55 58 64 74. NF has also been reported following blepharoplasty,43 47 51 56 dacryocystorhinostomy,48 surgical biopsy and excision,12 28 35 42 61 69 and self-puncture of a hordeolum externum. Infection can also develop as result of upper respiratory tract infection7 32 39 or carbuncle,55 insect7 23 52 59 62 or human44 55 bite, and tooth extraction 45 60…”

“…Unlike NF of the extremities and trunk where cultures are polymicrobial, the causative organism in periorbital infection (table 2) appears to be β-haemolytic Streptococcus7 10 11 14–16 19 20 23 24 26–28 31–35 37 39–42 45 47 48 51–53 55 56 61 63 70 73 74 (mainly S. Pyogenes ) alone but occasionally in combination with S. aureus 7 17 18 25 32 35 38 44–46 49 50 54 55 57 64. Rare causative agents include S. aureus alone,12 59 66 68 72 Pseudomonas aeruginosa ,62 67 Moraxella catarrhalis 65 and Cryptococcus neoformans 4 mainly in the setting of immunosuppression.…”

“…Hyperbaric oxygen therapy has only been used in few case of periorbital NF8 43 46 48 51 57 67 in which the patients had severe fasciitis. However, at present, more data from retrospective studies are needed to support the evidence of the benefits of hyperbaric oxygen therapy.…”

Periorbital necrotising fasciitis after minor trauma

“…Patients often suffer from diabetes mellitus, alcoholism or conditions requiring immunosuppression [7] although in many cases, there are no obvious sources of infection. Periorbital NF has been reported after trauma [5], and after surgery including dacryocystorhinostomy [3] and blepharoplasty [8].…”