Streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy

Necrotizing fasciitis is a rare infection of the deep and subcutaneous tissue layers most commonly caused by group A beta-hemolytic Streptococcus. The disease begins as a typical cellulitis. Necrosis of the deeper tissues progresses rapidly, accompanied by a dusky, gray-blue skin discoloration with erythematous margins. Even with appropriate treatment, mortality rates remain as high as 36%. Most cases of necrotizing fasciitis have been reported in the general surgical literature, associated with trauma or as a postoperative wound infection after abdominal and gynecologic procedures. Of the 50 cases involving the eyelids reported in the literature, only three were reported to have occurred as a "postoperative" complication. This report is of the first known case of streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy.