Necrotizing Tenon's capsule infection in a lymphopenic Down syndrome patient following strabismus surgery

Periocular infection is a rare complication of strabismus surgery. We describe a case of necrotizing Tenon's capsule infection after uncomplicated strabismus surgery in a boy with Down syndrome and blepharitis. Pathologic diagnosis was severe acute necrotizing inflammation with Gram positive coccal forms. Resolution of infection occurred after surgical debridement and intravenous and topical antibiotics. Work-up revealed lymphopenia related to Down syndrome. Patients with Down syndrome may have risk factors for postoperative infection including blepharitis and immunologic abnormalities.