Necrotising cellulitis occurring after cosmetic blepharoplasty: A case report

Periorbital necrotising cellulitis is a rare localisation of fasciitis and an exceptional complication of cosmetic blepharoplasty. We discuss here the case of a 52-year-old woman who presented with orbital cellulitis 2 days after undergoing a bilateral cosmetic lower blepharoplasty. The diagnosis was confirmed on magnetic resonance imaging. Cellulitis was complicated by ocular hypertension resistant to local treatment and intravenous acetazolamide, leading to a decrease in visual acuity. Infection management consisted of intravenous antibiotics, corticosteroid bolus and drainage surgery. Bacteriological samples yielded Staphylococcus epidermidis resistant to all betalactamines. Anatomopathological analysis of the drained sample revealed an aspect compatible with necrotising cellulitis. To our knowledge, this is the seventh case of necrotising cellulitis occurring after blepharoplasty reported in the literature. The other cases were due to the virulent Streptococcus pyogenes and required surgical debridement and antibiotics. Our case is unique, as it is the first reported case of necrotising cellulitis due to another pathogen, Staphylococcus epidermidis, which appears less virulent.